Value-Based Benefit Design
Value-based designs steer patients to effective treatment, but require an infrastructure to assess the evidence for effectiveness, incorporate it into the benefit structure, and update terms of coverage as evidence evolves.
*Milestone details:
*Full name: Decide whether to use value-based insurance design in Medicaid, CHIP, the basic health program, if adopted, public employee plans, or Exchange plans that vary patient cost sharing to correspond with clinical benefit.
*Relevance to the ACA:
Under the ACA, states have the authority to implement value-based benefit design in Exchanges and public programs, if they wish. In addition, the ACA employs value based benefit design in small portions of the Medicare program, and allows the Secretary to issue guidance on value-based designs by private insurers. States can decide whether to adopt value-based designs in addition or in parallel to those in Medicare and/or the private sector.
§1001 – The Secretary may develop guidelines to permit private health insurers to use value based insurance designs.
§3001, §3006, §3007, §10301 – Apply value based purchasing to hospitals, SNFs, physician fees, ambulatory surgical centers within the Medicare program.
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District of Columbia
In the April issue of Health Affairs, Thomson and coauthors report on their study of the use of value-based benefit design in several high income countries. Their findings suggest that efforts to increase use of VBID may result in an increase in the use of high-value care, but that they may also lead to increased health inequalities and higher administrative costs.
California
Last week, CPR released the first-ever National Scorecard on Payment Reform, the first glimpse at how we pays for care in the commercial sector. Just 11 percent of payment to providers is value-oriented- tied to how well they deliver care or creating incentives for both improving quality and reducing waste. Almost 90 percent remains largely in traditional fee-for-service, paying providers for every test and procedure they perform, regardless of necessity or outcome. Learn more about the results. http://www.catalyzepaymentreform.org/how-we-catalyze/national-scorecard
Michigan
The V-BID Center is pleased to note that three of the six successful SIM delivery system transformation grant proposals reference V-BID or V-BID principles. Additional SIM funding will be available, and we hope states consider options for including V-BID in those proposals.
MAINE:
"The CMS award will fund the following...(4) Patient shared decision-making training and tools, and support for value based benefit design (http://www.statereforum.org/sites/default/files/maine_sim_project_abstra...)
Payers will: (1) Participate in project governance – i.e. in the Project Advisory Committee; (2) Offer value based benefit design products aligned with MHMC member priorities (Page 42 here: http://www.statereforum.org/sites/default/files/maine_sim_project_narrat...)
OREGON:
"In 2013, PPO plan members who seek care from a recognized PCPCH will see a decrease in their cost sharing from 15% to 10%."
(Page 39 here: http://www.statereforum.org/sites/default/files/oregon_cmmi_sim_project_...)
ARKANSAS
"Both private payers and Medicaid are exploring options for value-based insurance designs, where individuals’ contributions to their insurance costs are changed to encourage the use of high-value care (e.g., lower co-pays or deductibles for the use of preventative services and medications effective in controlling a given condition) and discourage the use of low-value care (e.g., higher co-pays)." (Page 29 here: http://www.paymentinitiative.org/referenceMaterials/Documents/SIM%20III....)
Michigan
The University of Michigan's V-BID Center's latest issue brief highlights Connecticut's Health Enhancement Program, an uncommonly innovative initiative that is changing incentives for Connecticut state employees. The program is showing promising results in terms of utilization and cost. Learn more by reading the two-page brief.
Michigan
The University of Michigan's V-BID Center's latest issue brief highlights peer-reviewed evidence on the clinical and economic effects of changes in patient cost-sharing. The bottom line: strategies that includes both carrots and sticks may be particularly desirable for payers interested in implementing plans that will be cost-saving from an actuarial perspective in the short-term.
Michigan
The Center for Value-Based Insurance Design is pleased to announce the release of a new two-page issue brief, "Strategies for Health Insurance Exchanges to Promote Value-Based Insurance Design." V-BID refers to benefit designs that adjust cost-sharing to make high-value care more affordable and low-value care more expensive. Without deliberate policymaking, there's no guarantee that clinically nuanced V-BID plans—plans that deliver more health for the money—will be available to consumers on the exchange.
This brief, available at http://bit.ly/U2eR6T , discusses five policy options for states:
1. Require that plans in the exchange include key V-BID elements.
2. Allow benefit design flexibility for plans incorporating V-BID, and ensure adequate risk adjustment.
3. Allow or encourage carriers to market V-BID plans to consumers with specific conditions.
4. Highlight and promote V-BID plans when consumers search.
5. Recognize V-BID designs in quality ratings.
Has your state considered possibilities for promoting V-BID on the Exchange? Please tell us in a comment.
California
The Patient Protection and Affordable Care Act (PPACA) requires that health insurance plans offered through state exchanges cover a specific level of preventive, diagnostic, and therapeutic services defined as "Essential Health Benefits" (EHB) by the Secretary of Health and Human Services (HHS).
Health insurance plans that do not cover these services will not be considered adequate health insurance, and owners of such plans will be subject to a penalty as if they did not have coverage.
California
Key Issues for States - Revised publication with a summary of the HHS Guidance as announced on December 16th.
Michigan
The Center for Value-Based Insurance Design hosted its 2011 Symposium on November 16, 2011. The Tools and Integration Session highlighted the connections between IT and V-BID and included presentations from:
-Jeffrey Rideout, Senior Vice President, Chief Medical Officer, The Trizetto Group
-Thomas Tsang, Senior Advisor to the Governor, Healthcare Transformation, State of Hawaii
Michigan
The Center for Value-Based Insurance Design hosted its 2011 Symposium on November 16, 2011. The Implementation Session included presentations from:
-Margaret O'Kane, President, National Committee for Quality Assurance
-David Grossman, Medical Director, Group Health Cooperative
-Robert Krzys, Attorney; State Employees Bargaining Agent Coalition (SEBAC - Connecticut)
Michigan
The Center for Value-Based Insurance Design hosted its 2011 Symposium on November 16, 2011. The Evidence Session showcased the latest design ideas and included presentations from:
-Kevin Volpp, Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute; Director, UPHS Center for Innovations in Health Care Financing; Professor of Medicine and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania.
-Teresa Gibson, Senior Director of Health Outcomes, Thomson Reuters
Michigan
The Center for Value-Based Insurance Design hosted its 2011 Symposium on November 16, 2011. The Policy Session, which provided insights into the use of V-BID in exchanges, included presentations from:
-Stuart Guterman, Vice President, Payment and System Reform; Executive Director, Commission on a High Performance Health System, The Commonwealth Fund
-Alan Weil, Executive Director, National Academy for State Health Policy
-Steve Hilfinger, JD, Chief Regulatory Officer, State of Michigan; Director, Michigan Department of Licensing and Regulatory Affairs
Michigan
Last week, the Institute of Medicine released its report on Essential Health Benefits. The report calls in part for consideration of value-based benefits and the use of value-based insurance design (V-BID). The attached document gives more background information about V-BID and outlines policy principles that can guide its implementation in state health insurance exchanges.
District of Columbia
This report provides a background on the state’s health care system and highlights the issues that each subgroup has addressed since being established, including delivery reforms, technology, Medicaid and capacity. Access the report here: http://www.statereforum.org/sites/default/files/vhrifinal122010.pdf
District of Columbia
This presentation by the Oregon Health Authority outlines key action steps the state must take to implement its comprehensive health reform plan and includes elements of federal reform. Access it here: http://www.statereforum.org/sites/default/files/or_axn_plan_12.10.pdf
District of Columbia
The Iowa Legislative Health Care Coverage Commission presented 18 recommendations to General Assembly regarding implementation of the ACA. Highlights include planning for a new eligibility system to support Medicaid, CHIP, implementing a number of cost-containment strategies, and establishing an operational insurance information exchange by July 1, 2011.
Access the presentation here:
http://www.statereforum.org/sites/default/files/final_2010_comm_recommen...
District of Columbia
This report details the activities of the Value-based Health Care Workgroup of the Legislative Health Care Comission to date, including the meetings held by and presentations delivered to the workgroup over the course of the year.
Access the report here:
http://www.statereforum.org/sites/default/files/ia_value_based_group_rep...