|Health Factors:||Quality of Care|
|Decision Makers:||Employers & Businesses Healthcare Professionals & Advocates|
|Population Reach:||50-99% of WI's population|
|Impact on Disparities:|
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Value-based insurance design (VBID) creates financial incentives or removes financial disincentives to affect consumer choices and incentivize the provision of cost efficient health care services. Value-based insurance designs can also lower or eliminate copayments for high value services and medications or increase cost sharing for services considered to be of uncertain value. Value-based insurance plans often cover preventive care services, wellness visits, and treatments such as medications to control blood pressure or diabetes at low to no cost (NCSL-VBID).
There is strong evidence that value-based insurance design (VBID) increases patients’ adherence to medication and reduces their out of pocket expenses (Lee 2013, Tang 2014, Maciejewski 2014). Additional evidence is needed to confirm effects of VBID on clinical outcomes and health care utilization and spending (Tang 2014).
Value-based insurance plans that provide generous benefits, target high-risk patients, offer wellness programs, provide financial incentives only for medication ordered by mail, and do not offer disease management programs have a significantly greater impact on medication adherence (4-5 percentage points) than plans without these features (Choudhry 2014). VBIDs that target costs of low value as well as high value care are more likely to moderate cost growth and improve overall value than plans that only encourage the use of high value care; however, categorizing any health care services or medications as low value is politically challenging (Neumann 2010). A Connecticut-based study indicates greater use of standard preventive measures such as colonoscopies, pap smears, and lipid tests for all plan enrollees and increased service utilization for individuals with chronic conditions such as diabetes, heart disease, and asthma following VBID implementation (UM CVBID-CT brief 2015).
By reducing copayments and improving medication adherence, VBID appears to reduce racial and ethnic disparities, and improve cardiovascular disease outcomes for minority patients (Choudhry 2014a). VBID is also a suggested strategy to reduce disparities in health care outcomes among individuals with lower and higher incomes (UM CVBID-VBID brief 2014); however additional evidence is needed to confirm these effects (Tang 2014).
Overall, VBID appears to be cost neutral in the first three years after implementation, as increases in prescription drug spending balance reductions in non-drug medical spending (Tang 2014). VBID is a suggested strategy to reduce health care spending in the long-term, however, studies are needed to confirm effects over time (Lee 2013, NCSL-VBID).
The Affordable Care Act (ACA) Section 2713 mandates coverage of certain preventive care services through group health plans and individual health insurance coverage, establishes guidelines for using value-based insurance design, and restricts the use of cost-sharing or copayments for specified high value services and medications (US CMS-ACA Implementation). As of 2014, 40% of commercial in-network payments were considered value-oriented (CPR-2014 Scorecard).
Many local governments and public entities have implemented aspects of VBID in their public employee health plans, for example, the state of Oregon, Colorado Springs School District 11, and Chippewa County, Wisconsin. Many large companies and corporations have also implemented VBIDs, such as CVS Caremark, Pitney Bowes, Caterpillar, and Marriott International (NCSL-VBID).
In Wisconsin, insurance companies and health care providers are working together to implement VBIDs to improve quality of care while controlling costs, for example, Anthem Blue Cross Blue Shield Wisconsin and Aurora Health Care and its Aurora Accountable Care Network (HFMA-Butcher 2014).
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