Evidence That Value-Based Insurance Can Be Effective

Abstract

Value-based insurance design reduces patient copayments to encourage the use of health care services of high clinical value. As employers face constant pressure to control health care costs, this type of coverage has received much attention as a cost-savings device. This paper's examination of one value-based insurance design program found that the program led to reduced use of nondrug health care services, offsetting the costs associated with additional use of drugs encouraged by the program. The findings suggest that value-based insurance design programs do not increase total systemwide medical spending.

What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors

“…Because of the inelasticity (lack of price responsiveness) in drug purchasing behavior in commercially insured groups, a calculation of total cost change in a VBID program will produce a small estimated effect that understates the actual cost of VBID to the payer. Yet, only 1 of the 3 reports, the economic "break-even" analysis by Chernew et al, 43 transparently disclosed in the study report the implications of the analytic perspective for plan sponsors. Thus, when provided with information about VBID costs and benefits, health plan sponsors should check carefully to determine if payer costs were measured.…”

“…43 Unfortunately, no data on hospitalizations or ER visits-consequences of the "adverse clinical events" that the investigators had suggested would be prevented by the VBID-were reported.…”

“…83 The analysis plan indicated that study follow-up would end 30 months from improved worker productivity (e.g., reduced absenteeism and disability days), although not easily measured, are possible for active employee groups; 43 however, it is difficult to imagine that these effects would be substantial given the small size of the medication adherence effects.…”

Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities

“…2 VBID pharmacy programs commonly reduce copayments and patient costs for specific medications. Consequently, VBID pharmacy plan sponsors incurred a larger proportion of pharmacy costs for the treatment areas targeted.…”

Is the US “leading from behind” on health policy?

“…More are adopting value-based insurance design, which incorporates incentives for patients to use pharmaceuticals and other services in accordance with evidence of value [28,29]. Studies report increases in adherence rates from 3 to 6 % from such adjustments [30][31][32][33][34][35]. Similarly, some plans are requiring higher copayments for the use of low-value diagnostic imaging services to discourage overdiagnosis [36].…”