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Value-based Insurance Design

Value-based Insurance Design. 1. A New Approach to Benefits: Recognize Clinical Nuance. University of Michigan Center for Value-Based Insurance Design. 2. Sets consumer cost-sharing level on clinical Reduce or eliminate financial barriers to high-value clinical services and providers

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Value-based Insurance Design

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  1. Value-based Insurance Design 1

  2. A New Approach to Benefits: Recognize Clinical Nuance University of Michigan Center for Value-Based Insurance Design 2

  3. Sets consumer cost-sharing level on clinical Reduce or eliminate financial barriers to high-value clinical services and providers Successfully implemented by hundreds of public and private payers Value-based Insurance Design University of Michigan Center for Value-Based Insurance Design 3

  4. Study assessed impact of free access to preventive medications for Aetna members who had a heart attack Random trial reported in New England Journal of Medicine “Enhanced prescription coverage improved medication adherence and rates of (heart attacks) and decreased patient spending without increasing overall health costs.” Example: Waiving Co-Pays for Medications after a Heart Attack 4

  5. Participating employees receive a reprieve from higher premiums if they commit to: Yearly physicals, age-appropriate screenings/preventive care, two free dental cleanings Employees with certain chronic conditions must participate in disease management programs (which include free office visits and lower drug co-pays)  Early results: 99% of employees enrolled Decrease in ER and specialty care Increase in primary care visits Increase in chronic disease medication adherence Medical spending trend declined Implementing V-BID: Connecticut State Employees Health Plan 5

  6. Lowe's eliminates co-pays and pays travel costs if employees use the Cleveland Clinic for elective heart procedures Cleveland Clinic’s negotiated bundled price beats price of local hospitals Steering Employees to Centers of Excellence 6

  7. HSA-qualified HDHPs: Making Them Work for the Chronically Ill • More than 25% of employers now offer High Deductible Health Plans, many with qualified Health Savings Accounts • The clinical downside: Higher out-of-pocket costs may discourage employees from getting evidence-based medical services • The upshot: There is a movement to changes the rules to encourage enrollees with chronic diseases to get the care they need to manage their conditions Graphic: Western Health Advantage

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