CCHE Seminar Series: Coordinating Multi-Payer Health Care Systems

Coordinating Multi-Payer Health Care Systems

Lauren Cipriano
Ivey Business School, Western University

Friday March 1, 2024, 10am-12pm, HSB Rm. 412 and Zoom

Abstract: Multi-payer health care systems are common. In Canada and the United States, for example, many individuals are covered under private or employer-sponsored health plans prior to age 65 and, thereafter, covered by public insurance. We aim to analytically characterize the optimal treatment policy for a multi-state progressive disease within a single-payer system, compare the results to the optimal treatment policies in a multi-payer system, and to develop contracts between the payers that coordinate the system. We formulate the problem as a multi-decision-maker Markov decision process. We find that the treatment policies in a multi-payer system are a subset of the optimal treatment policy in a single-payer coordinated system. Therefore, multi-payer systems are sub-optimal for patients in addition to providing lower utility for the final payer and society. We integrate a game-theoretic model into the dynamic decision process to develop and evaluate a coordinating mechanism between the payers. We identify conditions under which contract mechanisms can coordinate the system and always cost the final payer less to implement than the cost of treatment. We demonstrate the framework numerically using access to hepatitis C treatment as a case study. This work has important implications for the final, often publicly funded, health care payer in a patient’s life. 

Lauren Cipriano is an Associate Professor at the Ivey Business School and in the Department of Medicine and Department of Epidemiology & Biostatistics at Western University where she holds the Canada Research Chair in Healthcare Analytics, Management, and Policy. She earned her PhD in Management Science and Engineering and MS in Statistics at Stanford University. Lauren’s research interests focus on the application of statistics, decision analysis, operations research, and systems analysis to health policy problems. Previously, Lauren worked at the Institute for Technology Assessment at Massachusetts General Hospital. Lauren was the 2018 winner of the Dr. Maurice McGregor Award for Health Technology Assessment and she is the Deputy Editor of Medical Decision Making and MDM Policy & Practice.