Lowering Cost-Share for High Value Meds Improves Adherence

By A. Mark Fendrick M.D., Margaret F. Shope, B.S. & Caroline E. Richburg

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What is Value-Based Insurance Design?

V-BID is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services to the patient. They are designed with the tenets of “clinical nuance” in mind — in that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where, and by whom the service is provided.

Does it work?

Yes — according to a literature review published in the July 2018 issue of Health Affairs. The researchers found that V-BID programs which reduced consumer cost-sharing for clinically indicated medications resulted in increased adherence at no change in total spending. In other words, decreasing consumer cost-sharing meant better medication adherence for the same total cost to the insurer.

Could Value-Based Insurance Design save money?

Currently, there are no published controlled studies on V-BID programs that limit the use of low-value care through increased consumer cost-sharing. Thus, the Health Affairs review covered only V-BID programs that reduce consumer cost-sharing for high-value services. Low-value care is defined as care that offers little to no clinical value or exposes patients to unnecessary harm, such as diagnostic testing before low-risk surgery or non-clinically indicated Vitamin D screening tests. It is estimated that the U.S. spends upwards of $200 billion per year on low-value care.

Imagining a Value-Based Future

Provider-facing initiatives such as accountable care and bundled payments encourage clinicians to prescribe medications that produce healthy outcomes for patients. However, these incentives do not always correspond to incentives in patients’ benefit design, particularly if high cost-sharing acts as a deterrent for high-value services and medications. Value-based insurance design aims to align these incentives to encourage patients and providers to choose the clinical service of the highest value to the patient.

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