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"Some 71 million Americans have received at least one free preventive service, like a mammogram or a flu shot, and an additional 34 million older Americans got free preventive services in 2012 under Medicare."
-New York Times, March 23, 2013, in an editorial describing the tangible benefits of the Affordable Care Act near its third anniversary

V-BID Newsletter
March 2013

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March's newsletter highlights:
  • RWJ research brief on showing long-term gains in medication adherence with V-BID
  • JAMA editorial on implementing low-value lists 
  • NASHP blog: the Connecticut experience and lessons for state health reform
  • Value-based payments to providers gain traction
  • Surveys show employers paying lower percentage of premiums, using incentives
  • Health Affairs looks at wellness programs, with mixed results  
  • JNCI: estimating the cost burden of breast cancer
  • HDHPs don't achieve cost savings over traditional plans with higher deductibles
  • MedPAC recommends Medicare Advantage use clinical nuance 
  • Video on the importance of aligning patient and provider incentives 
  • V-BID Center brief: Using V-BID in health information technology
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Building on previous work showing gains in medication adherence in the first year of a V-BID plan, a research brief from Changes in Health Care Financing and Organization, a program of the Robert Wood Johnson Foundation, reports that V-BID enrollment amplifies those gains in subsequent years. The research was originally published in the American Journal of Managed Care. 
LowValueImplementing lists of low-value medical services

This Journal of the American Medical Association Viewpoint article notes the "international groundswell of activity" to identify low-value services and difficulty in curtailing their use in a clinical setting. V-BID may help, the authors say. 
NASHPNASHP blog: V-BID in state reform and lessons from the Connecticut experience

V-BID Center staff authored a blog post discussing how states can use V-BID in reforming health insurance on staterefor(u)m.org, an initiative of the National Academy of State Health Policy. The post details opportunities for implementing V-BID as well as the experience of a state that has done so on a large scale. 
ValueCareMore insurance payments going to value-based care

As part of the effort to shift from volume to value, insurers are beginning to pay for care based on outcomes and value to patient care, according to a survey from Catalyst for Payment Reform. The survey of large insurers found that 11 percent of payments in 2012 went to "value-oriented" care. 
EmployersEmployers paying lower percentage of premiums, using more incentives

A Towers Watson/National Business Group on Health survey found that employees' share of insurance premiums is rising, up to 37 percent of total costs this year. The survey also found employers who concentrated on benefit innovation and value experienced lower than average cost growth and had healthier employees. A separate survey by Aon Hewitt, described in this news story, found that more employers are using rewards to encourage healthy behavior, and a growing number say they may soon start to penalize employees who engage in unhealthy behaviors such as smoking. 
WellnessWellness programs can reduce hospitalizations; incentives tricky
In its special issue on promoting health and wellness, Health Affairs includes a paper showing that an employer wellness program reduced hospitalizations for targeted conditions, but not overall costs in its first year. Another study in the same issue found that Medicaid programs to encourage healthy behavior had mixed results.  
JNCIJournal of the National Cancer Institute: estimating the cost of breast cancer

In one of the first studies to take an extensive look at the issue, researchers estimate that Canadian women and their spouses pay an average of more than $1,100 out-of-pocket in the year after an early-stage breast cancer diagnosis. An accompanying editorial notes the study likely underestimates the cost for U.S. patients.
High deductibles deter care in all benefit designs

Employers may not achieve savings by switching to a high deductible health plan over what they would save by raising premiums on a more traditional benefit design, according to the 2012 UBA Health Plan Survey. The survey found that the key to savings is high deductible, which acts as a deterrent to care regardless of plan type. 
MedPACMedPAC recommends incorporating clinical nuance into MA plans

In an annual report to Congress, the Medicare Payment Advisory Commission recommended that Medicare Advantage plans be permitted to vary benefits based on the medical needs of individuals with chronic conditions. Here's the summary and full report.   
Dr. Mark Fendrick, V-BID Center Director, explains the importance of clinical nuance and aligning physician and patient incentives in this short video from Hospitals and Health Networks magazine.

March's brief discusses the synergy between health information technology and V-BID, showing where IT enhances value-based principles and how clinical nuance can be used to inform IT system design.
The University of Michigan Center for Value-Based Insurance Design (V-BID) leads in research, development and advocacy for innovative health benefit designs.

To contact the V-BID center, email us at
vbidcenter@umich.edu or call 734-615-9635

For examples of V-BID programs from across the country, visit our V-BID registry.

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