'Smart spending' backers keep talking

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.