Notable Implementation Value-Based Insurance Design

1 notable implementation

1.1 federal , state policy

1.1.1 affordable care act section 2713 (c)
1.1.2 connecticut health enhancement program
1.1.3 michigan medicaid expansion
1.1.4 medicare advantage (2017 v-bid model test)


1.2 private implementation

1.2.1 pitney bowes
1.2.2 mayo clinic
1.2.3 novartis
1.2.4 sponsors of blue cross blue shield of north carolina administered plans

notable implementation
federal , state policy
affordable care act section 2713 (c)

v-bid principles incorporated patient protection , affordable care act of 2010 (sometimes known obamacare ). specifically, v-bid included in section 2713 (c). section 2713 of act requires health plans include preventive services without copayment patient. section 2713 (c) states:

value-based insurance design.—the secretary may develop guidelines permit group health plan , health insurance issuer offering group or individual health insurance coverage utilize value-based insurance designs.

in september 2010, secretary of health , human services (hhs) issued guidelines implementing health reform in affordable care act, including guidelines v-bid implementation.

connecticut health enhancement program

in 2011 connecticut implemented health enhancement program state employees. voluntary program followed principles of value-based insurance design lowering patient costs high-value primary , chronic disease preventive services, coupled requirements enrollees receive these services. nonparticipants in program, including removed noncompliance requirements, assessed premium surcharge. program created curb cost growth , improve health through adherence evidence-based preventive care.

a 2016 evaluation found in first 2 years of program, utilization of recommended services increased, medication adherence improved, , emergency room utilization decreased, relative control populations in other states.

michigan medicaid expansion

in september 2013, michigan became 25th state in nation expand medicaid under affordable care act. expansion created healthy michigan plan, relies on v-bid improve access, control costs, , enhance personal responsibility. examples of v-bid principles in expansion legislation include:

section 105d(1)(e): health plans permitted waive consumer copayments, promote greater access services prevent progression , complications related chronic diseases.
section 105d(1)(f): michigan department of community health (mdch) assigned design , implement copay structure encourages use of high-value services, while discouraging low-value services such non-urgent emergency department utilization.
section 105d(5): mdch assigned to, implement pharmaceutical benefit utilizes copays @ appropriate levels allowable cms encourage use of high-value, low cost prescriptions.

medicare advantage (2017 v-bid model test)

in 2015, centers medicare , medicaid services announced plans run v-bid demonstration project in medicare advantage. test occur in 7 states, slated start in 2017, , run 5 years. medicare advantage plans (sometimes known medicare part c plans) provide medicare part , b benefits utilize commercial insurance companies, not cms, claims. model test whether introduction of clinically nuanced v-bid elements medicare advantage plans’ benefit designs lead higher-quality , more cost-efficient care targeted enrollees.

private implementation
pitney bowes

one of earliest implementations of v-bid concept occurred in 1990s @ pitney bowes. wall street journal ran article. in 2004 detailing fortune 500 company s implementation of v-bid principles employee health-insurance plans. pitney bowes experienced $1 million savings reduced complications after lowering copayments asthma , diabetes medication.

in 2007, pitney bowes eliminated copayments cholesterol-lowering statins employees , beneficiaries diabetes or vascular disease , lowered copayments employees , beneficiaries prescribed clot-inhibiting drug clopidogrel. policy associated immediate 2.8 percent increase in adherence statins relative controls. clopidogrel, policy associated immediate stabilizing of adherence rate , four-percentage-point difference between intervention , control subjects year later.

mayo clinic

in 2004, mayo clinic s self-funded health plan increased cost sharing employees , dependents specialty care visits , other services such imaging, testing , outpatient procedures. plan removed cost sharing visits primary care providers , preventive services such colorectal screening , mammography. result large decreases in use of diagnostic testing , outpatient procedures sustained 4 years, , immediate decrease in use of imaging. beneficiaries decreased visits specialists did not make greater use of primary care services.

novartis

on january 1, 2005, novartis pharmaceuticals implemented value-based insurance program medications used treat 3 chronic conditions: asthma, hypertension, , diabetes. program employees , dependents enrolled in company s self-insured health benefit plan. part of program, copayments eliminated, , members paid 10% , 7.5% of cost of retail , mail order prescriptions, respectively, drugs used in treatment of asthma, hypertension, , diabetes. program resulted in increase in net payments drugs used in treatment of asthma, hypertension, , diabetes, increase offset decrease in net payments medical services specific or related these conditions. offset sufficient in asthma , diabetes cohorts produce net savings in 2007 compared 2004.

sponsors of blue cross blue shield of north carolina administered plans

in january 2008, blue cross blue shield of north carolina instituted value-based insurance design program medications treat diabetes, hypertension, hyperlipidemia, , congestive heart failure. copayments brand-name medications lowered of insurer s enrollees, while generic copayments waived employers opted program. adherence improved enrollees, ranging gain of 3.8 percentage points patients diabetes 1.5 percentage points taking calcium-channel blockers, when compared others employers did not offer similar program.