CENTER UPDATE | Late June 2020

This update features policy developments, media reports, and events
supporting continued momentum for multiple V-BID Center initiatives from mid to late June.

CMS Proposed Rule Aims to Foster More Medicaid Value-Based Drug Agreements

On June 17th, the Centers for Medicare & Medicaid Services issued a proposed rule that provides states more flexibility to form value-based purchasing agreements with drug makers. The rule aligns with CMS’s recent moves towards paying for value instead of volume.

Trump Health Officials Pledge COVID-19 Vaccine Will Be Free to the 'Vulnerable'

A Trump administration official shared that the government will provide any potential COVID-19 vaccine for free to “vulnerable” Americans who cannot afford it. The CARES Act also mandates commercial insurers to cover COVID-19 vaccines without cost-sharing, once they become available.

Mandatory HIV Drug Coverage with Employer Health Plans

Employer health plans will be required to fully cover the cost of HIV pre-exposure prophylaxis (PrEP) drugs, effective with plan renewals on and after July 1, 2020. HIV PrEP was issued an “A” recommendation by the U.S. Preventive Services Task Force (USPSTF) in June 2019, as these drugs can reduce the risk of HIV infection for high-risk individuals by 92%, if taken consistently.

Re-Examining the Delivery of High-Value Care Through COVID-19

In this opinion, authors John Rother, Katy Spangler, and V-BID Center Director Mark Fendrick highlight the current opportunity to align incentives for providers and consumers as medical practices and hospitals reopen. Payment policies should drive incentives to improve individual and population health, rather than increase the volume of services delivered.

Low-Value Testing & Imaging Increases Downstream Utilization and May Cost Healthcare Billions

Results published in JAMA Internal Medicine show that patients who receive low-value screenings as part of their annual wellness visits are more likely to undergo downstream testing and specialist appointments. These screenings can expose patients to unnecessary harm and cost the health system $101 billion annually. Learn more about reducing low-value care from our initiative page.

Consumer-Direct Health Plan Enrollment Rises in All Cities over 10 Years, Pushes Physicians to Change Practice

The percent of commercially-insured individuals enrolled in consumer-directed health plans (a type of high-deductible health plan, or HDHP) quadrupled between 2008 and 2017, causing changes in physician practice patterns. While HDHPs offer lower premiums, enrollees with existing conditions are required to pay out-of-pocket for necessary services prior to meeting the plan deductible, resulting in potentially lower care utilization, poorer health outcomes, and higher costs. Read about V-BID’s role in improving HDHP designs here.

A Scalpel Instead of a Sledgehammer: The Potential Of Value-Based Deductible Exemptions in High-Deductible Health Plans

This Health Affairs blog presents value-based high-deductible plans as a potential solution to flawed high-deductible health plans. Incorporating V-BID principles in HDHPs would include allowing clinical nuance to inform consumer cost-sharing, encouraging the use of high-value care, and limiting the utilization of low-value care.

Crisis Into Opportunity: Can COVID-19 Help Set a Path to Improved Health Care Efficiency?

The COVID-19 pandemic led to an unprecedented decrease in medical visits and procedures, creating a unique opportunity to enhance the efficiency of health care delivery. A recent AJMC commentary, co-authored by V-BID Center Director Mark Fendrick, advocates for investing in high-value services and deterring the resurgence of low-value care as facilities reopen.

Value-Based Insurance Design in Louisiana: Blue Cross Blue Shield's Zero Dollar Co-pay Program

An analysis of Blue Cross Blue Shield of Louisiana’s Zero Dollar Co-pay program found that eliminating pharmacy co-pays for medications related to four chronic diseases led to an 18% decrease in total health spending. This V-BID program focuses on the most at-risk patients and offers a more comprehensive set of medications with no cost-sharing compared to previous studies.

Animated Video: A Clinically Driven Approach - The Value-Based Insurance Design Model

Consumer cost-shifting, especially within high-deductible health plans, can be a blunt financial barrier that reduces the use of both high-value and low-value care. Watch our new video to see how the value-based insurance design model can improve access to high-value services while “screening” out low-value care.

Please Help Support the V-BID Center

As a non-profit entity, the V-BID Center relies on fundraising to support our research, education, and policy efforts. Please help us continue our work by donating here. We truly appreciate your consideration.

V-BID Center Update: CMS Proposed Rule Encourages Medicaid Value-Based Drug Agreements