Out of Pocket Cost Calculator for NY Consumers Selecting Health Insurance Plans

Official Title
Health Insurance Marketplace Transparency Calculator: Out-of-Pocket Costs for Specialty Conditions
New York
11/2016 – 11/2018
IMPAQ Health
Practice Areas
Payment & Service Delivery Models
Pharmaceutical Health Services Research
Population Health
Research Services
Policy/Program Analysis
Advanced Analytics & Technology Solutions
Data Management
Surveys & Data Collection
Data Collection & Operations
New York State Health Foundation
Analysis and Validation
In-depth Interviews
Quantitative Data Analysis

The objective of this project is to make health plan information more transparent and usable for New York State consumers by creating a New York-specific out-of-pocket-cost (OOPC) calculator. The tool focuses on pre-selected, high cost, but relatively common health care conditions, such as hepatitis, HIV, heart disease, or schizophrenia. The tool will allow consumers shopping for health insurance in New York’s individual and small-group health insurance markets to compare differences in OOPCs for treating those specified conditions across plans sold in their county. This will help consumers make more informed decisions when selecting a health plan that best fits their medical needs.

IMPAQ incorporates patient demographic information, plan cost-sharing data, and patient utilization information to create plan-specific OOPC calculations that give consumers a more realistic picture of OOPCs from different health plans. By taking into account the clinically-recommended medical services and prescription drugs that a consumer with a high-cost medical condition tends to utilize in a given year, this methodology provides an OOPC estimate that better aligns with patient experiences compared to existing OOPC tools. IMPAQ is also engaging several stakeholders in New York state throughout the calculator development process to ensure that the calculator is customized to meet the specific needs of New Yorkers.

IMPAQ is a leader in health insurance & marketplaces policy and operations, leveraging its subject matter expertise with federal and state private health insurance policy and data to ensure the successful implementation of this project. The IMPAQ team consists of economists, health policy experts, data scientists, and clinical and pharmaceutical specialists with decades of combined experience in health insurance marketplace policy, qualitative and quantitative data analytics, pharmaceuticals, clinical guideline reviews, and tool development.