Evaluating two novel, population-tailored health insurance designs: impact on diabetes outcomes

Active Project Grant Awarded Last action

Award ID
R01DK143928
Recipient
Awarding agency
Obligated
$1,650,418

Award facts

Completion date 24% complete
Place of performance
Durham, NC 27710, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Low-income people with diabetes are struggling with the high costs of health care. Among working age adults, this is often caused by high-deductible health plans (HDHP) that require annual out-of-pocket payments of up to $16,000 per family. Hdhps are attractive to employers and some workers because of their low monthly pre- miums that have the potential to increase real wages. However, after 2010-15, as HDHP prevalence exceeded 30-40%, rates of acute and chronic diabetes complications began rising among younger adults. Experts are concerned that the cost barriers under hdhps are partially contributing. In an attempt to avoid such harms among low-income workers while providing affordable premiums, an in- creasing number of employers are adopting a novel approach. In recent years, approximately 11-18% of firms have selectively provided more generous health benefits to only their low-income workers. For example, EM- ployers might provide free diabetes medicines ("preventive drug lists") or low deductibles to hourly workers while executives receive hdhps. Such "population-tailored" designs represent a potentially major advance in decades-long efforts to improve both equity and cost efficiency in the private U.S. Health system. Population-tailored designs could especially improve outcomes in diabetes given its disproportionate impact on low-income people. Nevertheless, health and financial effects of such designs are unknown. The overarching goal of this project is therefore to assess whether population-tailored insurance designs improve DIA- betes care, outcomes, and spending. Analyses will leverage a large, national health insurance claims data- base from 2019-2028 to study approximately 1.75 million working age adults at risk for adverse diabetes-RE- lated outcomes. The specific aims are: 1. Assess 10-year trends in the adoption of population-tailored health insurance designs. 2. Evaluate impacts of low-deductible-based population-tailored designs on diabetes screening and diagnosis. 3. Examine effects of employer switches to low-deductible-based population-tailored designs on secondary preventive diabetes care, acute preventable diabetes complications, and diabetes-related spending. 4. Determine effects of employer switches to $0 preventive drug list-based population-tailored designs on SEC- ondary preventive diabetes care, acute preventable diabetes complications, and diabetes-related spending. The research will use the most rigorous observational study designs including controlled interrupted time series and segmented survival. Results could demonstrate that population-tailored plans increase diabetes secondary prevention, improve health outcomes, and reduce employer spending versus HDHP-only employers. In a health system dominated by cost-prohibitive hdhps and cost-related disparities, such evidence could enhance employer adoption and inform national policymaking efforts to encourage uptake of population-tailored plans. These efforts could move the U.S. Toward being a more equitable, efficient, and affordable health system.

Transactions

Action Obligated Date
Amendment $806,933
Amendment $15,375
Original award $828,110

Subawards

Subrecipient Amount Awarded
Harvard Pilgrim Health Care, Inc. Evaluating two novel, equity-focused health insurance designs: impact on diabetes outcomes $351,034

Quick answers

Who received award R01DK143928?

R01DK143928 was awarded to Duke University by National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health) on September 5, 2025.

How much is award R01DK143928 worth?

$1,650,418 has been obligated on R01DK143928.

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