Health Insurance Quality Value-Based Purchasing

VBID in practice

In a typical insurance plan, patients have a fixed copayment, insurance and deductible regardless of whether the treatment they receive is considered high or low value.  However, an alternative insurance structure–known as value-based insurance design (VBID)–uses a different approach.  Under VBID, patient cost sharing is higher for low-value treatments and lower or eliminated for high-value treatments.

One such VBID program was Connecticut’s Health Enhancement Program for its state employees. Enacted on October 1, 2011, the program:

…introduced incentives to align patient costs with the value of care, including the elimination of office visit copayments for chronic conditions (a savings of $15 per visit) and the reduction or elimination of copays for medications associated with the management of the five following chronic conditions targeted by the program: asthma or chronic obstructive pulmonary disease (COPD), diabetes, heart disease, hypertension, and hyperlipidemia….Additionally, the program assessed a new $35 copay for emergency department (ED) visits when there is a reasonable medical alternative and the member is not admitted to the hospital…A novel feature of the program is its attempt to engage patients in preventive care by holding them accountable for receiving it. Members who desire to maintain Health Enhancement Program benefits must satisfy a number of requirements, including obtaining health risk assessments, screenings, and physical examinations that are appropriate for people of their age and sex.

Although the program was voluntary, Connecticut state employees that enrolled in the Health Enhancement Program were exempt from a monthly $100 health insurance premium surcharge and and also were exempt from any deductibles.

Using data for enrollees aged 18-64 between July 1, 2010 and June 30, 2013, a study by Hirth et al. (2016) compared changes in health care cost and utilization between Connecticut state employees and state employees from other states. The authors found that:

During the program’s first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program’s impact on costs was inconclusive and requires a longer follow-up period.


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