• Reading list

    The first three papers listed below are from the latest issue of Health Affairs, which has a lot more on value based insurance design.

    Assessing The Evidence For Value-Based Insurance Design, by Niteesh K. Choudhry, Meredith B. Rosenthal, and Arnold Milstein

    High copayments for medical services can cause patients to underuse essential therapies. Value-based health insurance design attempts to address this problem by explicitly linking cost sharing and value. Copayments are set at low levels for high-value services. The Mercer National Survey of Employer-Sponsored Health Plans demonstrates that value-based insurance design use is increasing and that 81 percent of large employers plan to offer it in the near future. Despite this increase, few studies have adequately evaluated its ability to improve quality and reduce health spending. Maximizing the benefits of value-based insurance design will require mechanisms to target appropriate copayment reductions, offset short-run cost outlays, and expand its use to other health services.

    HMO Coverage Reduces Variations In The Use Of Health Care Among Patients Under Age Sixty-Five, by Laurence C. Baker, M. Kate Bundorf, and Daniel P. Kessler

    Variation in the use of hospital and physician services among Medicare beneficiaries is well documented. However, less is known about the younger, commercially insured population. Using data from the Community Tracking Study to investigate this issue, we found significant variation in the use of both inpatient and outpatient services across twelve metropolitan areas. HMO insurance reduces, but does not eliminate, the extent of this variation. Our results suggest that health plan spending to better organize delivery systems and manage care may be efficient, and regulations that arbitrarily cap plans’ spending on administration, such as minimum medical loss ratios, could undermine efforts to achieve better value in health care.

    Copayment Reductions Generate Greater Medication Adherence In Targeted Patients, Matthew L. Maciejewski, Joel F. Farley, John Parker and Daryl Wansink

    A large value-based insurance design program offered by Blue Cross Blue Shield of North Carolina eliminated generic medication copayments and reduced copayments for brand-name medications. Our study showed that the program improved adherence to medications for diabetes, hypertension, hyperlipidemia, and congestive heart failure. We found that adherence improved for enrollees, ranging from a gain of 3.8 percentage points for patients with diabetes to 1.5 percentage points for those taking calcium-channel blockers, when compared to others whose employers did not offer a similar program. An examination of longer-term adherence and trends in health care spending is still needed to provide a compelling evidence base for value-based insurance design.

    Out of Whack: Pricing Distortions in the Medicare Physician Fee Schedule, by Robert A. Berenson

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