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PPACA: Agencies Seek VBID Comments

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Federal agencies are asking for comments on how health insurers and group health plans can use the “value-based insurance design” (VBID) concept to improve coverage of recommended preventive services.

Officials at the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA), and the Office of Consumer Information and Insurance Oversight (OCIIO) have posted VBID questions today in the Federal Register.

Advocates of the VBID approach to health plan design want to use information and incentives to get consumers to choose high-value providers and treatments, rather than trying to save money by discouraging consumers from getting any care, or simply encouraging them to choose the cheapest providers and treatments.

Earlier this year, IRS, EBSA and OCIIO officials released interim final regulations implementing provisions of the Affordable Care Act – the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) – that require non-grandfathered insuers and health plans to cover specified in-network preventive care screenings and procedures without imposing deductibles or co-payments.

The agencies received about 25 VBID comment letters, with some commenters asking the agencies to protect use of the VBID approach and others suggesting it might reduce some patients’ access to services.

The agencies “remain interested in promoting high-value, clinically effective, evidence-based preventive care,” officials say. “To inform future guidance, this [request for information] solicits additional information on specific examples and best practices of VBID for recommended preventive services, as well as data used to support and inform VBID benefit design, measurement, and evaluation in the context of recommended preventive services.”

The agencies ask questions such as,

“What specific plan design tools do plans and issuers currently use to incentivize patient behavior, and which tools are perceived as most effective?”, “What considerations do plans and issuers give to what constitutes a high-value or low-value treatment setting, provider, or delivery mechanism?” and “To the extent a low-cost alternative treatment is reasonable for some or the majority of patients, what happens to the minority of patients for whom a higher-cost service may be the only medically appropriate one?”

Comments are due Feb. 28, 2011.