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Kim Bailey Health Action 2014 January 23, 2014

Kim Bailey Health Action 2014 January 23, 2014. Consumer-Friendly Value Based Insurance Design. Roadmap: Four Key Questions. Families USA 2014. What is the policy context in which VBID is emerging? What is VBID? How can VBID programs be designed in a consumer-friendly way?

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Kim Bailey Health Action 2014 January 23, 2014

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  1. Kim Bailey Health Action 2014 January 23, 2014 Consumer-Friendly Value Based Insurance Design

  2. Roadmap: Four Key Questions Families USA 2014 • What is the policy context in which VBID is emerging? • What is VBID? • How can VBID programs be designed in a consumer-friendly way? • What are the key differences between VBID and wellness programs?

  3. Policy Context Families USA 2014 1) Health care expenditures are high and rising

  4. Health Spending as a Share of GDP, Select OECD Countries, 2000-2010 U.S. OECD Avg. Families USA 2014 Source: Health at a Glance 2013: OECD Indicators, available online at: http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf.

  5. Policy Context Families USA 2014 Health care expenditures are high and rising As a result, premiums continue to grow, too

  6. Premiums for Employer-Based Coverage, 1999-2013 * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013. Families USA 2014

  7. Policy Context Families USA 2014 Health care expenditures are high and rising As a result, premiums continue to grow, too Employers and other purchasers are looking for ways to contain the cost of coverage

  8. Value-Based Insurance Design Families USA 2014 Two Models: 1) Tiered cost-sharing based on clinical value 2) Tiered cost sharing by quality and efficiency of provider Goal: To control costs and improve access to effective, evidence-based care and providers

  9. Key Elements to Effective VBID Families USA 2014

  10. VBID: Tiered Cost-Sharing Families USA 2014 How it works • Reduces/waives cost-sharing for services with evidence of strong clinical benefit relative to cost • May increase cost-sharing for services that are not clinically effective Requirements for consumer-friendly design • Robust, reliable evidence base • Accessible exceptions and appeals • Consumer education and the availability of tools and resources to aid consumers • Paired with policies that address provider pricing and behavior

  11. Value-Based Care Families USA 2014

  12. VBID in Practice: Tiered Cost-Sharing Sources: Choudhry NK, Rosenthal MB and Milstein A. Assessing the evidence for value-based insurance design. Health Affairs. 2010 Nov; 29(11): 1988-94 and Choudhry NK et al. At Pitney Bowes Value-Based Insurance Design Cut Co-payments and Increased Drug Adherence. Health Affairs 2010 Nov.; 29(11): 2028-31. Families USA 2014 Pitney Bowes Experience Design: Reduced/waived co-pays for medications for heart disease, asthma, diabetes and hypertension Results: • Improved medication adherence for statins and blood clot inhibitors • Reduced ER visits by 26% in diabetics • Slowed rate of cost growth

  13. VBID: Tiered Provider Networks Families USA 2014 How it works • Providers placed into tiers based on performance data and other factors • Cost-sharing varied based on tier within which provider falls Requirements for consumer-friendly design • Robust, reliable quality metrics and measures of provider performance • Sufficient availability of providers to meet the needs of all plan enrollees • Consumer education on plan design • Accessible exceptions and appeals

  14. VBID in Practice: Tiered Provider Networks Families USA 2014 Aetna Aexcel Performance Network Design: Designates doctors and provider groups in 12 specialties (e.g. cardiology and orthopedics) as high-performing with a blue star Factors considered: • Volume • Clinical Performance • Efficiency Sources: http://www.aetna.com/docfind/pdf/aexcel_understanding.pdf and http://www.aetna.com/insurance-producer/document-library/aexcel-member-brochure.pdf

  15. VBID vs. Wellness Penalties Families USA 2014

  16. Families USA 2014

  17. Additional Resources Families USA 2014 • Principles for Consumer Friendly Value-Based Insurance Design: http://familiesusa2.org/assets/pdfs/VVBID-Brief.pdf • Key Difference between Wellness Reward/Penalty Programs and Value-Based Insurance Design: http://familiesusa2.org/assets/pdfs/health-system-reform/VBID-Wellness-Programs.pdf

  18. Contact Information Families USA 2014 Kim Bailey Kbailey@familiesusa.org 202-628-3030 Familiesusa.org

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