CENTER UPDATE | FeBRUARY 2021

This update features policy developments, media reports, and events
supporting continued momentum for multiple V-BID Center initiatives throughout the end of January and early February.

Significant Employer Uptake of IRS Rule Expanding Pre-Deductible Coverage of Chronic Disease Services

The 2020 Kaiser Family Foundation Survey of Employer Health Benefits reported significant uptake of a 2019 federal rule that expanded the number of clinical services that may be covered before enrollees meet their plan deductibles. Of employers offering an HSA-qualified health plan, 48% of employers with over 5000 employees and 29% of employers with over 200 employees reported adopting a benefit design that permitted individuals with chronic conditions to receive services pre-deductible.

Biden Administration National Strategy for COVID-19 Response Ensures No Out-of-Pocket Costs for Vaccines

On January 21st, 2021, the Biden Administration released a report detailing the new national strategy for COVID-19 response. The Administration pledged to ensure that “safe, effective, cost free vaccines are available to the entire U.S. public” (p. 47). Learn more about the role of V-BID in the COVID-19 response by viewing our video.

How Top Payers Are Providing COVID-19 Vaccine Coverage, Support

The Coronavirus Aid Relief, and Economic Security (CARES) Act requires health plans that comply with the Affordable Care Act to cover the COVID-19 vaccine with no consumer cost-sharing. However, some payers are now sharing additional ways they intend to support COVID-19 vaccination efforts.

Promoting High-Value Care: A Conversation with Mark Fendrick, MD

The Choosing Wisely initiative recently spoke with V-BID Center Director Mark Fendrick about the state of value-based insurance design and how to best identify, measure, report on and reduce the billions of dollars spent every year on low-value services. Read more about steps that can be taken to reduce the use of low-value care from our infographic.

Relentless Health Value Podcast: Surprising Insights About Value-Based Care

In a new interview on the Relentless Health Value Podcast, V-BID Center Director Mark Fendrick discusses the concept of clinical nuance, the importance of aligning provider and patient incentives to increase high-value care utilization, and the ways reduced spending on low-value services could create headroom for spending on high-value care.

Effects of Employer-Offered High-Deductible Plans on Low-Value Spending in the Privately Insured Population

While some argue that high-deductible health plans limit wasteful spending by incentivizing reductions in low-value care, others worry these plans lead patients to indiscriminately reduce health care use. In a recent study, HDHPs were associated with a 5.2% reduction in overall patient spending, including a 13.7% reduction in spending on low-value care. The findings suggest that HDHPs are a relatively blunt instrument for reducing care utilization.

PCPs Play a Small Part in Low-Value Care Spending

A new report published in the Annals of Internal Medicine indicates that most primary care physicians generate only a small part of the billions of dollars wasted every year on low-value care. In an interview, V-BID Center Director Mark Fendrick stated that the report confirms that low-value care must be reduced across all medical disciplines in order to improve coverage for essential services.

Health Care Resource Utilization and Costs Associated with Nonadherence and Nonpersistence to Antidepressants in Major Depressive Disorder

Patients with major depressive disorder, who where nonadherent and nonpersistent to antidepressant medications in a retrospective cohort study, were more likely to experience higher total medical costs, more hospitalizations and ER use. Strategies that promote better adherence and persistence, such as lowering out-of-pocket costs for antidepressant medications, may reduce these outcomes.

Association of Out-of-Pocket Spending with Insulin Adherence in Medicare Part D

Research published in JAMA Network Open found that high out-of-pocket costs for insulin were associated with reduced insulin adherence among Medicare Part D beneficiaries. These findings suggest that the new 2021 Medicare Part D Senior Savings Model, which will cap beneficiaries’ out-of-pocket insulin costs at $35 per month, has the potential to significantly improve insulin adherence for participants.

Fifty-One Percent of U.S. Workforce Enrolled in High-Deductible Health Plans, Which May Leave Some Underinsured

Analyses conducted by ValuePenguin revealed that 51% of the workforce in the United States was enrolled in a high-deductible health plan in 2019 – the highest percentage over the past five years. While HDHPs generally offer cheaper health insurance premiums compared to other plans, members with high medical bills could be exposed to significant out-of-pocket costs.

Survey: Most People Don't Think High Deductible Health Plans Save Money

A survey conducted by researchers at In sur e.com found that 40% of respondents enrolled in a high-deductible health plan delayed medical care due to cost. Delayed medical care can potentially lead to higher long-term health costs and poorer health outcomes. HDHPs are now able to develop a more flexible benefit design that offers more protection for certain medical services through a V-BID plan structure.

Seniors on Medicare: 2020 Health Care Challenges and Priorities for 2021

Interviews with Medicare beneficiaries revealed that seniors have several clear health policy priorities for the coming year, including reducing out-of-pocket costs for prescriptions. Respondents also reported that the COVID-19 pandemic impacted their health care decisions, leading them to avoid or delay seeing their provider, delay treatment for a chronic condition, or prioritize taking a prescription drug for one condition over another.

Survey: Few Americans Could Pay A Surprise $1,000 Bill From Savings

Bankrate’s January Financial Security Index finds that fewer than 4 in 10 U.S. adults could currently afford to cover an unexpected expense of $1,000. The pandemic has placed many Americans in more perilous financial situations, making the adoption of flexible HSA-HDHP plan designs even more important.

Patients Praise Medicare Advantage as Hospice Carve-In Takes Effect

Up to 98% of Medicare Advantage beneficiaries reported satisfaction with their coverage and services in a recent Better Medicare Alliance poll. Poll results were released shortly after the inception of the V-BID Medicare Advantage hospice carve-in on January 1st, 2021. Click here to learn more about how V-BID principles have been incorporated in Medicare Advantage.

Patients With Atopic Dermatitis Report Broad Array of OOP Expenses Related to Disease

More than forty percent of survey participants with atopic dermatitis reported that their annual out-of-pocket expenses exceeded $1,000. The majority said their atopic dermatitis was either moderate or severe, and patients often used both prescription and non-prescription therapies. Health care providers and patients with atopic dermatitis must work to create a treatment plan that minimizes financial burden.

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V-BID Center Update: Significant Uptake of IRS Rule Expanding Pre-Deductible Coverage of Chronic Disease Services