Clinical and Equity Implications of Braidwood v. Becerra AFFORDABLE CARE ACT PREVENTIVE SERVICES PROVISION Preventive services can help people avoid acute illness, identify and treat chronic conditions, prevent cancer or lead to earlier detection, and [...]
It is well documented that populations of color and low-income individuals are less likely to receive the clinical services that play a critical role in preventing and managing disease. A more recent and growing evidence base suggests that underserved communities are also at risk of receiving more low-value care, defined as services that provide little or no benefit to patients, have potential to cause harm, incur unnecessary cost to patients, and/or waste limited healthcare resources.
Precision Patient Assistance Programs to Enhance Access to Clinically Indicated Therapies: Right Drug, Right Time, Right Cost-Share Cost-Sharing and its Consequences Consumer cost-sharing for medical care and medications is high and getting higher. The average [...]
The 2010 Patient Protection and Affordable Care Act (ACA) called for the creation of a health insurance exchange in each state. As of the 2020 plan year, there are 13 state-based marketplaces, six state-based exchanges on the federal platform, six state-federal partnership marketplaces, and 26 fully federally-run marketplaces, altogether providing coverage for 11.4 million Americans.
The High-Cost Plan Tax, or “Cadillac Tax” was established in Section 49801 of the Patient Protection and Affordable Care Act (PPACA)1. Originally slated to be implemented in 2018, the tax has been twice delayed by Congressional action, most recently in January of 2018. Now scheduled to take effect in 2022, the excise tax will be levied on certain generous health plans.
Originally Produced: June 2013 Updated: January 2019 Implementing Value-Based Insurance Design in Medicare Advantage Introduction Due to misaligned incentives, Medicare beneficiaries currently receive too little high-value care and too much low-value care. Value-Based Insurance [...]
Outcomes-Based Contracting with Value-Based Insurance Design: Opportunities to Drive More Health per Pharmacy Dollar Background Reimbursement that aligns spending with quality and patient-centered outcomes is widely viewed as a key enabler of achieving more value [...]
Cost-Sharing for Immunizations in Medicare: Impacts on Beneficiaries and Recommendations for Policymakers Introduction Vaccine-preventable diseases affecting adults cost the US nearly $9 billion per year, including $5.9 billion in inpatient costs alone.1 Yet [...]
V-BID in Action: A Profile of Connecticut’s Health Enhancement Program Value-Based Insurance Design (V-BID)—hailed as a “game changer” by the National Coalition on Health Care— refers to insurance designs that vary consumer cost-sharing to distinguish [...]
A 'Dynamic' Approach to Consumer Cost-Sharing for Prescription Drugs Access to, and levels of spending on, prescription drugs has become an important public policy issue. Given the significant individual and population health gains that result [...]
V-BID in Action: The Role of Cost-Sharing in Health Disparities The existence of health disparities among specific populations has long been recognized; substantial variations in health insurance coverage, access to providers, use of specific clinical services, [...]
Shifting the health care system from “volume-to-value” has become a common theme in health care reform discussions. Benefit designs that engage consumers in their health care, while also encouraging access to high-value and appropriate care, are of particular interest.
Health Information Technology & V-BID: A Synergistic Combination IntroductionValue-Based Insurance Design (V-BID) is an innovative approach that can improve clinical outcomes and contain costs. The basic premise of V-BID is to align consumer incentives with value [...]
Narrow Networks and Value-Based Insurance DesignExecutive SummaryNarrow networks aim to improve patient outcomes and increase quality of care by establishing a pool of providers to supply consumers with high-value, evidence-based care. This concept incorporates Value-Based Insurance [...]
Potential Role for “Clinically Nuanced” V-BID Plans in Private Exchanges Growth in Private Exchanges Employers are increasingly challenged to offer competitive benefits that attract and retain talent while simultaneously control employee health care costs. While [...]
