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.