National Pharmaceutical Council Request for Proposals – New Research on High-Deductible Health Plans

About NPC's Research

The National Pharmaceutical Council (NPC) is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation. NPC focuses on research development, information dissemination, education and communication of the critical issues of evidence, innovation and the value of medicines for patients.

NPC’s current research examines the most pressing topics related to real-world evidence, the optimal role and value of pharmaceuticals in emerging payment and delivery models, and biopharmaceutical and health system innovation.


Proposal Topic

High-deductible health plans (HDHPs) are characterized by high deductibles that enrollees must meet before traditional medical and pharmacy coverage begins. In recent years, in an effort to address rising health care costs, the deductibles associated with HDHPs have substantially increased. An annual survey of employer health benefits found that 11% of workers enrolled in a single coverage HDHP had a deductible of $3,000 or more, compared with only 6% in 2012.  As HDHPs become increasingly prevalent, and more costs are borne by the patient, it is critical to understand how the HDHP plan design impacts consumer behavior and patient outcomes. 

Much of the evidence base to date explores early experience with HDHPs and indicates that such plans can lead to reduced health care utilization as enrollees delay or avoid care. When patients indiscriminately reduce their health care utilization to save money, necessary and beneficial care may be deferred, leading to suboptimal health outcomes and unnecessary costs elsewhere in the system. This can be of particular concern for patients who are lower income and/or chronically ill.

As the prevalence of HDHPs continues to increase, and as the deductibles associated with these plans continue to rise, NPC is interested in exploring new research that will build on the existing evidence base to explore how the proliferation of this benefit design affects consumer behavior and patient outcomes.


Proposal Scope

NPC is interested in exploring research that uses a robust database and rigorous methodologic approach, and emphasizes an interest in the impact of relatively high deductibles rather than nominal deductibles. A suitable database is critical for an analysis of the impact of HDHPs on health care utilization. Required elements include:

  • Sufficient population size
  • Availability of a meaningful comparison group – comparison group could consist of:
    • a pre-post analysis of the same population prior to adoption of a HDHP, or
    • a concurrent analysis of HDHP vs. a more traditional plan (e.g., PPO) or a concurrent analysis of two HDHP designs with varying levels of generosity (e.g., no preventive medications covered for HSA vs. broad preventive medications covered or traditional Rx card plan carved out for HRA vs. no carve out). Concurrent analyses must be designed in such a way as to avoid selection bias.
  • Details about health plan design (e.g., deductibles, preventive/other services that are carved out of the deductible, size of contribution employer makes to HSA/HRA)
  • Integrated medical and Rx data to allow for comprehensive analyses of utilization and outcomes
  • Demographic information to identify particularly vulnerable populations such as low-income

NPC is interested in proposals that focus on, but are not limited to, the following research questions and topics:

  1. Is health care utilization reduced under HDHPs?
  2. What types of treatments and services are reduced (e.g., biopharmaceuticals, outpatient visits, diagnostic tests, emergency room visits, hospitalizations)?
  3. Does necessary and beneficial care appear to be deferred?
  4. Can impact on health outcomes be observed or inferred?
  5. Does impact vary by certain HDHP design characteristics (e.g., deductible amount, more services carved out of deductible, employer contributions to HSA/HRA)?
  6. Are low income and/or chronically ill patients disproportionately affected by HDHPs? How big of an impact is that having?

We welcome and encourage all research ideas that are pertinent to this topic. The project budget should not exceed $325,000[1], and shorter term-projects (<12 months) with a budget less than $200,000 will be given higher priority in review. NPC research activities have an indirect cost cap of 25%. 


Submission Guidelines

Submissions will be evaluated based upon a combination of factors, including: the potential impact of the research; availability of data and content; project duration; probability of technical success; cost; and to what extent the research is important to key audiences.

Submissions should be sent to Lisabeth Buelt, Research Associate at NPC, and should conform to NPC’s proposal template. Proposals must be submitted no later than 5pm March 15, 2018. If you are interested in submitting a proposal but are unable to meet this deadline, please let us know. NPC will follow-up with all research proposals within eight weeks of the submission deadline.

To access past NPC-funded research, please visit http://www.npcnow.org/research.  If you have any questions, please contact Lisabeth Buelt (lbuelt@npcnow.org ). Thank you for your interest and participation.

 


[1] If your proposed research meets the methodological and database specifications described above but the budget exceeds $325,000, please contact NPC staff to discuss your proposal in greater detail prior to submission.