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'Smart spending' backers keep talking

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Promoters of the “value-based insurance design” (VBID) strategies are still trying to get their share of employer, insurer and policymaker mind share.

The promoters are hoping they can make waves by showing their approach can improve productivity and cut disability costs as well as cutting short-term medical costs.

VBID program managers try to set up co-payments, coinsurance rates, deductibles and plan networks in ways that encourage people to get high-value care they clearly need, such as blood pressure checks and efforts to keep diabetes under control, while reducing their incentive to get unnecessary care, potentially harmful care, or care of marginal value, such as antibiotics for colds, or questionable back surgery.

Drafters of the Patient Protection and Affordable Care Act (PPACA) tried to build a little VBID goodness into the law by including a section that requires all non-grandfathered individual policies and group plans to cover a package of high-value preventive services, such as checkups, and vaccinations for children, without imposing any co-payment requirements, deductible requirements or other out-of-pocket costs on the patients.

But VBID backers have struggled to get the same kind of dollars-and-cents respect given to plan designers who try to hold down coverage costs with more direct approaches, such as minimizing the number of doctors and hospitals in the plan’s provider network in an effort to send those providers as many patients as possible at the very lowest possible rates.

One knock against VBID programs is that the programs take so long to reduce costs that employers and plans have trouble getting any return on their investments in a reasonable length of time.

One company in the VBID market, SeeChange Health Solutions, recently looked at about 100,000 people who had been in its employer-sponsored VBID programs for three years. The company is reporting that 42 percent of the enrollees had completed more than half of the “health actions,” employers were encouraging, such as getting blood pressure checks and cancer screenings, and that 12 percent had completed all of the actions.

Over that three-year period, hospital admissions decreased in about 10 percent to 20 percent, and hospital readmissions fell about 50 percent, SeeChange reported.

Meanwhile, Kimberly Jinnett, a researcher at the Integrated Benefits Institute, and Tom Parry, the president of the institute, have reported in a paper published in the online version of the American Journal of Managed Care that use of a VBID approach to get patients with rheumatoid arthritis to take the recommended medications can help them keep working.

The researchers found that increasing patient adherence to a program of early and aggressive medication use can reduce the likelihood that employees with rheumatoid arthritis will file short-term disability (STD) insurance claims in the following year by about 65 percent.

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