CENTER UPDATE | May 2021

This update features policy developments, literature items, media reports, and events supporting continued
momentum for multiple V-BID Center initiatives throughout late April and early May.

Chronic Disease Management Act of 2021 Introduced in Senate

On April 28th, 2021, Senators John Thune (R-SD) and Tom Carper (D-DE) introduced the Chronic Disease Management Act of 2021 in the United States Senate. This bill builds upon previous versions of the CDMA and follows guidance issued by the U.S. Department of Treasury in 2019 to further increase the flexibility of HSA-HDHPs to cover chronic disease services on a pre-deductible basis. A companion bill (HR. 3563) was introduced in the House of Representatives in May 2021.

Ease HSA Users' Access to Mental Health Care: Employer Group to Congress

Large employers are asking Congress to make it easier for enrollees in health savings accounts to get mental health care for no or low cost prior to meeting the plan deductible. Representatives for employers with self-insured health plans are also calling for Congress to make first-dollar coverage for telehealth services permanent.necessary COVID-19 care.

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Rethinking Health Insurance Design

To improve access to care, it is essential to incorporate nuance in enrollee benefit design. High levels of cost-sharing deter the use of high-value care as well as low-value care. This JAMA Health Forum article posits that more thoughtful use of patient cost-sharing can be a powerful tool to promote better use of health care resources without imposing barriers to needed care.

How Payer COVID Waivers Model Value-Based Health Care Spending

Payers eliminated cost-sharing for coronavirus treatment when the pandemic hit the U.S. in March 2020. Now they have the opportunity to use those waivers as a model for reducing low-value care spending and investing in high-value care across the industry. V-BID Center Director Mark Fendrick discusses how payers can implement these strategies on a recent episode of the Healthcare Strategies podcast.

A Path Forward for Alternative Payment: Build a Portfolio, Not a Garden

The Centers for Medicare and Medicaid Innovation’s approach has focused on testing and diffusing many alternative payment models to determine successful programs. However, as V-BID Center Co-Founder Michael Chernew discusses in a new viewpoint and podcast, a more coordinated portfolio paradigm is needed to eliminate low-value care, lower spending, and improve quality.

Low-Value Care, Including CVD Screening for Low-Risk Adults, Costs Medicare $478M Per Year

A study on the utilization and cost of seven low-value services that received a “D” recommendation from the U.S. Preventive Services Task Force found that these services are ordered more than 31 million times per year. The cost associated with this care is $478 million per year. Learn more about the impact of low-value care from our infographic.

Patient Support Program for Painful Conditions May Reduce Opioid Use

Patients with autoimmune disorders often have high out-of-pocket costs and complicated regimens for necessary biologic medications. A new study, co-authored by V-BID Center Director Mark Fendrick, found that the addition of a multi-faceted patient support program, along with specialty medication, led to better patient-centered outcomes, such as reduced opioid use, when compared to the use of medication alone.

Correlation Between Changes in Brand-Name Drug Prices and Patient Out-of-Pocket Costs

New research indicates that consumers see an increase in out-of-pocket costs above and beyond their insurance copays when drug manufacturers raise prices for brand-name prescription medications. Increasing the list price of a brand-name drug by 17% results in a nearly 4% increase in out-of-pocket costs for patients with deductibles and coinsurance.

Trends in Out-of-Pocket Healthcare Expenses Before and After Passage of the Patient Protection and Affordable Care Act

An analysis published in JAMA Network Open found that the Affordable Care Act has slowed increases in out-of-pocket costs by 80% for those with health insurance coverage under the law. Out-of-pocket savings may be driven by ACA-imposed spending limits for HDHPs and improved access to coverage for previously uninsured individuals.

Association of Drug Rebates and Competition With Out-of-Pocket Coinsurance in Medicare Part D, 2014 to 2018

The current drug rebate system places additional burden on patients exposed to list price-based coinsurance, particularly for more competitive drug classes. A new cohort study found that mean drug list prices were 34% to 61% higher than mean net prices. This burden could be alleviated if payers passed rebates through to patients at the point of sale.

Trends in Total and Out-of-Pocket Payments for Noninsulin Glucose-Lowering Drugs Among Privately Insured U.S. Adults

Average annual payments and out-of-pocket payments for noninsulin glucose-lowering drugs increased significantly from 2005 to 2018. Switching from older low-cost drugs to newer high-cost medications was the main driver for payment increases during this period and could lead to higher patient costs. These findings raise questions of whether new drug classes improve long-term clinical outcomes and are cost-effective compared to older drugs.

Controller Medication Use and Exacerbations for Children and Adults with Asthma in High-Deductible Health Plans

A recent study found that in a population where medications were exempt from the deductible for most enrollees, HDHP enrollment was associated with minimal or no reductions in controller medication use for children and adults and no change in asthma exacerbations. The findings suggest a potential benefit from exempting asthma medications from the deductible in HDHPs.

Qualitative Exploration of Barriers to Statin Adherence and Lipid Control

During a randomized clinical trial of financial incentives for statin therapy adherence, participants who did not see improvements in LDL cholesterol had lower incomes, greater clinical illness burdens, and higher rates of unemployment compared to those who saw improvements. Future interventions should consider addressing socio-economic circumstances in combination with adherence interventions for patients with high cholesterol levels.

A 10-Step Program to Successfully Reduce Low-Value Care

One way to reduce the cost of health care in the U.S. is by identifying and eliminating low-value care. The authors of a recent AJMC article outline how the frequency of low-value care can be reduced by a respectful, data-driven process anchored in non-judgmental communication and explicit core values.

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V-BID Center Update: Bipartisan Chronic Disease Management Act Reintroduced in Senate