Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence

Abstract

In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services.

The effect of increased cost‐sharing on low‐value service use

“…Additionally, VBID principles are being applied in demonstration projects within Tricare, a healthcare program that provides healthcare benefits to US Armed Forces military personnel and retirees and their dependents. States have also implemented such principles into their employee benefit plans (Burns, Dyer, & Bailit, 2014; Gibson, Maclean, Chernew, Fendrick, & Baigel, 2015; Hirth, Cliff, Gibson, McKellar, & Fendrick, 2016). A survey of large US firms documents that 81% either currently incorporate VBID principles in their benefit packages or will introduce these principles in the future (Gibson et al, 2015).…”

Assessing social values for California's efforts to reduce the overuse of unnecessary medical care

“…This strategy is specific to prescribed interventions with considerable cost variations. Recently, some health plans have introduced higher cost‐sharing when patients use certain services unnecessarily, such as using the Emergency Department without sufficient cause . But both these examples are ones where the patient is the seeker of services; the physician is not making a treatment decision or choosing where and how the patient seeks a treatment.…”

The Impact of Increased Cost-sharing on Utilization of Low Value Services: Evidence from the State of Oregon

“…Several studies that examine V-BID programs targeting high value services with reduced cost-sharing suggest that while such programs improve adherence and increase medication/service use, they may not lead to substantial -or any -reductions in costs (Lee, Maciejewski et al 2013, Maciejewski, Wansink et al 2014, Hirth, Cliff et al 2016, Sepúlveda, Roebuck et al 2016. These studies imply that V-BID programs that reduce cost-sharing for high value services may not generate the savings that program designers might hope would be 8 achieved through better health and thereby lower rates of adverse events triggering emergency room visits or hospitalizations.…”

“…Using a differences-indifferences design, the authors find no evidence that increases in cost-sharing impacted ED utilization within the Medicaid population. However, Hsu, Price et al (2006a) and Hirth, Cliff et al (2016) find that increases in cost-sharing do reduce ED usage, although the effects on overall healthcare costs are inconclusive. Thus, the ability of V-BID programs to reduce low value healthcare service utilization and costs may be context-specific.…”

“…1 Medicare Advantage has explicitly adopted V-BID into its Health Plan Innovations Initiative. 2 U.S. states have also implemented such principles into employee benefit plans (Gibson, Maclean et al 2015, Hirth, Cliff et al 2016. A recent survey of large firms documented that 81% either currently incorporate V-BID principles in their benefit packages or plan to introduce these principles in the near future (Gibson, Maclean et al 2015).…”