July 2007

Grant Results

SUMMARY

Mark Earnest, Ph.D., M.D., of the University of Colorado Medical School and a team of Pueblo, Colo., physicians created a modified version of CHAT (Choosing Healthplans All Together), a health insurance simulation in which consumers participate in the creation of an imaginary insurance plan with a fixed budget and a limited menu of options.

The modified version of CHAT supports a larger initiative, sponsored by the Dr. A.J. Kauvar Foundation and other health care stakeholders in Colorado, to create an affordable, basic health coverage plan for low-income, uninsured workers in Pueblo, Colo.

Key Results

  • The researchers created the "CHAT High-Value Game Board for Pueblo." Modeled on the original pie-shaped CHAT game board, it is divided into 10 benefit areas.
  • Small groups of low-income, uninsured workers use the game board to design a basic benefit package with a value of about $150 per month, compared to about $350 in traditional CHAT.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a grant of $25,000 from January 2005 to August 2006 to support this unsolicited project.

 See Grant Detail & Contact Information
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THE PROBLEM

To reduce the number of uninsured people in the United States (46.6 million in 2005), insurers must design affordable insurance plans that deliver quality services while also controlling costs. Cost-containment measures include reduced benefits, higher premiums and co-payments.

Some researchers, including a team from the University of Michigan and the National Institutes of Health (NIH), believe that one way to contain costs while educating consumers about the need for such trade-offs is to give them a voice in the design of their own insurance plans. In the 1990s, the NIH and University of Michigan researchers created a health insurance game called CHAT (Choosing Healthplans All Together) that lets small groups of consumers design an insurance plan, using a menu of benefit options and a fixed budget.

In the original CHAT, players use a pie-shaped game board divided into more than a dozen benefit areas — such as dental care, home health care, hospital care, drug coverage, mental health and primary care — to design a benefit package worth about $350 per month, the cost of a typical employer-sponsored insurance plan in 2006.

Traditional CHAT users are insured workers. Modifications of CHAT should consider the preferences of low-income, uninsured workers and the importance of educating them about evidence-based treatment guidelines and how they can help patients — and their physicians — choose cost-effective, high-quality treatment options.

For information on CHAT, which was supported by NIH and RWJF (Grant ID# 036801), see the Web sites of the NIH, Department of Clinical Bioethics and the University of Michigan.

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RWJF STRATEGY

This project was funded under the auspices of RWJF's Quality team. This team seeks to accelerate performance improvement on nationally adopted measures of outpatient chronic care quality through local market demonstrations.

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THE PROJECT

From January 2005 through August 2006, Mark Earnest, Ph.D., M.D., of the University of Colorado Medical School, and a team of 10 Pueblo, Colo., physicians created a modified version of the original CHAT. The team conferred with NIH researcher Marian Danis, M.D., co-creator of CHAT, on the need for a "high-value" game board with affordable, high-quality benefit options for low-income, uninsured individuals.

In selecting benefits for the "high-value" game board, the research team used as a model Access Health Muskegon, an affordable, basic health coverage plan for low-income, uninsured workers in Muskegon, Mich.

Christopher Adams, president of the Adams Group, a Denver public policy consulting organization, administered the project on behalf of the Dr. A.J. Kauvar Foundation.

Other Funding

RWJF provided a grant of $25,000 from January 2005 to August 2006 to support the project. The A.J. Kauvar Foundation provided a matching grant of $25,000. See the Appendix for additional funders.

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RESULTS

  • The researchers created the "CHAT High-Value Game Board for Pueblo." Modeled on the original pie-shaped CHAT game board, the revised game board has 10 benefit areas (dental, home health, hospitalization, mental health, pharmacy, primary care, specialty care, tests, vision and special treatment for life-threatening situations).
  • The revised CHAT gives players, low-income, uninsured workers, a limited budget of about $150 to $165 for an affordable, basic benefits package. According to the researchers, the choices in the revised board are much starker than those in the original version of CHAT, which is based on a typical employer-sponsored insurance plan, worth about $350 to $450 per month.
  • The revised CHAT offers incentives favoring primary care and preventive services. Some more expensive services are not offered at all (limb reattachment, for example). Others appear on the game board (fertility treatments, for example), but players must decide whether they are willing to give up something else to buy them.

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AFTER THE GRANT

The researchers are using the modified CHAT in a pilot demonstration to assist with the design of a health plan for low-income workers. It will also be used as an educational tool.

The project has garnered community support, including financial support. Pueblo's two hospitals have each provided $200,000 for operations. The Pueblo Chamber of Commerce is assisting with the rollout of the demonstration project, and the Colorado Legislature passed a law in 2007 allowing the project to go forward on a pilot basis without being regulated as typical insurance. The A.J. Kauvar Foundation provided ongoing funding, along with other Colorado philanthropies and the hospitals. (See Appendix for a complete list.)

Information about Health Access Pueblo is available online.

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GRANT DETAILS & CONTACT INFORMATION

Project

Understanding the Role of Evidence-Based Medicine and Benefit Design in Doctor-Patient Decision Making

Grantee

Dr. A.J. Kauvar Foundation (Denver,  CO)

  • Amount: $ 25,000
    Dates: January 2005 to August 2006
    ID#:  052290

Contact

Christopher F. Adams
(303) 282-9250
chris@theadamsgroup.org

Web Site

http://www.theadamsgroup.org

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APPENDICES


Appendix 1

Funders

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Report prepared by: Richard Camer
Reviewed by: Jayme Hannay
Reviewed by: Marian Bass
Program Officer: Anne F. Weiss