Washington, July 13, 2016 – According to the American College of Physicians (ACP), consumer cost-sharing, particularly deductibles, may cause patients to forgo or delay care, including medically necessary services.   ACP’s position paper, “Addressing the Increasing Burden of Health Insurance Cost-Sharing,” recommends the implementation of value-based insurance design (V-BID) as a potential solution to make patient cost-sharing more equitable.

The ACP’s endorsement of V-BID builds on multi-stakeholder and bipartisan support, including the incorporation of V-BID principles in Section 2713 of the Patient Protection and Affordable Care Act requiring the elimination of consumer cost-sharing for specified preventive care services, the CMS MA-VBID demonstration project set to begin in seven states in January 2017, and the H.R. 5652, “Access to Better Care Act of 2016,” that allows high deductible health plans the flexibility to provide coverage for services that manage chronic disease prior to meeting the plan deductible.

Each of these programs align with the ACP’s call for initiatives to reduce the burden of health insurance cost-sharing.

ACP Position Paper Page 7:

“To encourage use of high-value health care, employer-sponsored health plans should:

a.  Consider implementing value-based insurance design strategies that reduce or eliminate out-of-pocket contributions for services proven to offer the greatest comparative benefit, with higher cost-sharing for services with less comparative benefit.  Such strategies should be based on rigorous comparative effectiveness research by independent and trusted entities that do not have a financial interest in the results of the research.  The goal should be to ensure that high-value cost-sharing strategies encourage enrollees to seek items and services proven to be of exceptional quality and effectiveness and not just on the basis of low cost;

b.  Consider implementing income-adjusted cost-sharing approaches that reduce or directly subsidize the expected out-of-pocket contribution of lower-income workers to avoid creating a barrier to their obtaining needed care.”

A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID Center, is available for questions or comments.  To learn more about V-BID policy initiatives, please view our interactive policy timeline.