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August 13, 2013 In a recent New York Times article, Harvard economist Sendhil Mullainathan articulates strong support for clinically nuanced value-based insurance design (V-BID) programs.  Mullainathan highlights the well-documented problem of cost-related medication non-adherence and recommends that high-value drugs such as those that treat heart disease and diabetes be provided at no cost to the populations that need them. The concept of 'clinical nuance' was developed at the University of Michigan Center for Value-Based Insurance Design.  The basic tenets of clinical nuance are: 1) medical services and providers differ in the benefit provided; and 2) the clinical benefit of the service depends on the person using it, as well as where and by whom the service is provided.  Unlike "one-size-fits-all" plan designs that set a single co-payment for all clinician visits, diagnostic tests and drugs, V-BID programs base cost-sharing on the clinical value of the service--not the cost.  Published evidence [...]

June 25, 2013 Value-Based Insurance Design (V-BID), a concept developed and researched by the V-BID Center at the University of Michigan, has garnered recent attention from high profile state health policy makers.  In a U.S. House of Representatives Energy and Commerce Committee hearing, Anthony Keck, Director of the South Carolina Department of Health and Human Services, testified that he was a "strong believer in V-BID" and hoped to use clinically nuanced designs in the state's Medicaid program.  View the video here.  Medicaid policy expert Seema Verma supported the use of V-BID in Medicaid during her testimony at the same hearing. Separately, during a national summit on state health insurance exchanges, Dr. Joshua Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, noted that his state was examining V-BID's role in the Maryland Health Benefits Exchange and that the V-BID concept could "improve health outcomes and lower costs."  View the video here. Both Sharfstein and Keck [...]

April 17, 2013 A recent report published by the Partnership for Sustainable Health Care and funded by the Robert Wood Johnson Foundation singled out the adoption of Value-Based Insurance Design (V-BID) as one of five recommendations to sustain affordability and quality in America's health care system.  This inclusion again highlights the V-BID concept as one of a small number of ideas with strong, bipartisan support to control costs, enhance clinical outcomes and create a better experience for patients. The report is the result of discussions of a diverse group of organizations that came together over the past year to develop reforms to improve efficiency, efficacy and value in the U.S. health system.  Influential groups including America's Health Insurance Plans, Families USA, the Pacific Business Group on Health, the National Coalition on Health Care, Ascension Health and the American College of Surgeons contributed to the report. "Value-Based Insurance [...]

February 7, 2013 According to two recently published reports, the successful implementation of value-based insurance design (V-BID) in state exchanges is contingent on transparency and consumer education efforts.  As officials from California and other states contemplate V-BID options for their exchanges, the commentaries initiate a roadmap to effective execution. A Robert Wood Johnson Foundation funded study, published in this month's Health Affairs, praises V-BID plans for their ability to align provider/patient incentives and "reward value of care over volume of care."  The authors note the trade-offs between the flexibility required to implement clinically nuanced value-based insurance designs and the simplification permitted by a standard benefit design.  In their analysis, the authors note the evidence base for V-BID and recommend ways to support consumers who may be interested in choosing these plans. A second paper from Consumers Union lays out six evaluative criteria that should be met by California [...]

November 2012, Ann Arbor, MI In their plan for health and fiscal policy, the National Coalition on Health Care (NCHC) refers to value-based insurance design (V-BID) as a "game-changer", putting the concept of value in insurance design at the forefront of ideas that could address fiscal challenges and transform health system incentives. Released earlier this month, the NCHC plan was written after a year of intensive discussions with health experts and others involved in health care delivery.  The plan recommends a policy framework for curbing costs without sacrificing quality and explicitly cites V-BID for its ability to "give consumers incentives to seek out the highest value care." The report references V-BID Center Director Dr. Mark Fendrick's testimony before the Senate Committee on Health, Education, Labor, and Pensions, and suggests that Congress "implement MedPAC's recommendation to empower the Secretary of Health and Human Services (HHS) to vary cost-sharing based on [...]

Evidence accumulates for Value-Based Insurance Design:  Adherence improvements enhanced by plan characteristics February 20, 2012 The basic premise of Value-Based Insurance Design (V-BID) is to align consumer incentives with value by reducing barriers to high-value health services and providers ("carrots").  When "carrots" are used in a clinically nuanced manner, V-BID improves health care quality and controls spending growth.  The concept of clinical nuance recognizes that: 1) medical services differ in the benefit provided; and 2) the clinical benefit derived from a specific service depends on the patient using it, as well as when and where the service is provided. Recent evaluations add to the published evidence that clinically nuanced copayment reductions lead to improvements in medication adherence.  A 2014 Journal of Managed Care Pharmacy study reported that copay reductions for Medicare beneficiaries prescribed statins resulted in a 5.9% increase in adherence over 6 months compared to those paying standard copayments.  A second [...]