How can we improve mental health services provided by employers?

At the American Psychiatric Association meeting last week, the APAM Center provided some suggestions. AJMC reports that their 5 policy recommendations include: Create action plan to insure network adequacy. “Employers can start by expanding services at the inpatient and outpatient levels, and engaging regional and national organizations to add providers, including specialty providers. They can…

Estimating the price elasticity of demand through value-based formulary designs

In 2010, Premera Blue Cross (Premera), a large nonprofit health plan in the Pacific Northwest implemented a value-based formulary design for its beneficiaries.   In essence, enrollees could purchase high-value treatments for low copayments and low-value treatments for higher copayments.  Can we use this change from more standard to value-base formulary designs to estimate the price elasticity…

Precision Benefit Design

A recent viewpoint from Fendrick and Shope (2018) argues for the need for Precision Benefit Design. Successful implementation of precision medicine will need to address several system-wide challenges, including administrative complexities, the creation of new financing models, and aligning provider- and patient-focused initiatives. The enormous clinical potential of precision medicine sheds light on the critical…

VBID in TRICARE

Value-based insurance design looks to be expanding. As the American Journal of Managed Care reports: The bill calls for a pilot demonstrating the feasibility of incorporating VBID by “reducing co-payments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers” no later…

Do narrow networks reduce cost?

Many health plans in the Obamacare health insurance exchanges aim to keep premiums down by limiting patients to a select group of providers (e.g., hospitals, physicians). The thought is, by limiting patients to a “narrow network” of providers, patients are in essence restricted to see the most efficient providers.  Some may claim that “efficient” means high quality…