Health plans should be able to use financial incentives to encourage consumers to shop for reasonably priced preventive care services.
Dr. Jeffrey Levin-Scherz, a consultant in the Boston office of Towers Watson, has made that argument in a comment on a federal value-based insurance design (VBID) initiative.
Levin-Scherz is one of the commenters who responded to a December 2010 request from the Internal Revenue Service, the Employee Benefits Security Administration and the Consumer Information and Insurance Oversight Office for comments about the VBID concept.
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 improve their health and 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.
The Patient Protection and Affordable Care Act (PPACA) has encouraged federal agencies to look into VBID and other ideas for increasing the quality of care and lowering the cost. Another section of PPACA requires health insurers and health plans to cover a designated set of preventive services, such as mammograms and blood pressure checks, with no co-payments, deductibles or other cost-sharing charges for the patients.
Levin-Scherz says regulators ought to think carefully about how to apply that requirement.
Even many employers with plans that have “grandfather” status are decreasing or eliminating out-of-pocket costs for key preventive services, because they agree on the importance of encouraging plan participants to get those services, Levin-Scherz says.
But there are some preventive services that are easy to get, available at a high level of consistency and quality, and have highly variable prices, Levin-Scherz says.
He notes that the cost of one common screening service, digital mammography, can range from $50 to $750, and that the highest amount charged for mammography and other common services is often 6 times the average cost.
“We believe that mandating zero member cost sharing at all providers, even those outside the contracted network, would encourage rampant increase in the prices for these services, which would ultimately limit our clients’ ability to afford to support preventive care services,” Levin-Scherz says. “We recommend that benefit sponsors be given the freedom to limit support for zero cost-share services to those facilities that offer their services at affordable prices, provided there is reasonable, timely access to the service.”