Consumer groups and provider groups are wary of value-based insurance design programs, but health insurers and employer groups say VBID regulations should be as flexible as possible.

Designers of VBID programs try to use careful use of insurance plan features, such as co-payments and deductibles, to encourage patients to take the steps most likely to hold down their overall health care costs.

A VBID program might waive co-payments for people with diabetes who are buying insulin and getting regular eye exams, and it might increase co-payments or deductibles for care provided by unusually expensive providers.

Three federal agencies – the Internal Revenue Service, the Employee Benefits Security Administration (EBSA) and the Center for Consumer Information and Insurance Oversight – put out a request for comments about the VBID concept in December 2010.

EBSA recently posted the VBID comments it received on its website.

Groups such as Families USA, Washington, asked the agencies to avoid giving health insurers and others enough leeway to skimp on coverage for reasonable patient care.

“If not done properly, value-based insurance design could improperly limit patient access to providers and needed health care services,” says Michealle Gady of Families USA. “Any value-based insurance design must be structured in a way that keeps in mind that many consumers currently lack knowledge about the value of health care services and providers and the ability to make informed decisions about their health care (i.e. knowledge gap), as well as the structure of our current health care system, which includes a significant shortage of primary care providers.”

Dr. O. Marion Burton, president of the American Academy of Pediatrics, Elk Grove Village, Ill., warned against letting VBID programs keep children from benefiting from advances in scientific knowledge or getting adequate preventive care.

“There is no greater testament to the value of prevention and early intervention during childhood than the demonstration of poor adult health directly related to the absence of optimal care during childhood,” Burton says. “Any efforts undertaken to restructure health benefit plans to accommodate a growing interest in value based insurance design for preventive care services must understand the potential risks that could result in diminished access to a set of benefits that promote healthy children today and a creative and productive workforce tomorrow.”

Carmella Bocchino, an executive vice president at America’s Health Insurance Plans (AHIP), Washington,

says the government does not need to impose additional rules to, for example, keep patients in VBID programs from getting adequate preventive care.

“It is important that these approaches be allowed to be modified based on consumer input and not limit the flexibility of plans in designing the VBID,” Bocchino said. “These programs are rapidly evolving as new evidence-based clinical guidelines and research becomes available”

“Because VBID is still an emerging area with considerable promise, it is critical that health plans have the flexibility to experiment and to innovate,” says Justine Handelman of the Blue Cross Blue Shield Association, Chicago.

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