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"You don't want to put a co-pay into value-pricing that keeps people from using services that they may need."


Congressman Morgan Griffith
(R-VA) Ways and Means Health Subcommittee hearing Making Medicaid Work for the Most Vulnerable.   


V-BID Newsletter
July 2013

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July's newsletter highlights:
Follow us on twitter for the latest news on health care transformation, benefit design, and payment reform.

CMS recently released a final rule updating several provisions in the ACA related to Medicaid plans. This cost-sharing update can enhance the use of high-value clinical services and reduce utilization of unnecessary and costly services, while fostering consumer engagement and personal accountability. Read our July issue brief on V-BID's role in Medicaid.

Health Affairs reviewed thirteen published studies to assess V-BID's impact on medication adherence and expenditures. Overall, incentive-only V-BID plans improved adherence and lowered out-of-pocket spending for drugs. Offering more generous coverage did not change overall medical spending for patients and insurers. Studies examining V-BID plans that include disincentives for low-value services are warranted.
New research from the Florida Health Care Coalition indicates that individuals enrolled in V-BID plans over a three-year period had higher adherence rates for diabetic medications while overall employer healthcare costs declined. The full report is available.  
Penn State University unveils V-BID plans for employeesPenn

Penn State officials have expanded benefit plan coverage options to their employees that include V-BID principles. This plan option will provide high-value services such as office visits, laboratory services, and tests at no cost for individuals who are diagnosed with high blood pressure, high cholesterol or diabetes.
146 ineffective, low-value medical interventionsIneffective

After a decade of study, researchers have concluded that over 40 percent of new or existing medical practices were proven to be ineffective, while 38 percent reaffirmed their clinical value, and 21 percent proved inconclusive. Researchers called for increased efforts to publicize information about low-value medical interventions and requirements for stronger evidence before recommending practice guidelines. 
AJMC:  Encouraging V-BID in State Health Insurance Exchanges  AJMC_VBID 

States have a unique opportunity to implement V-BID plans on the exchange. Investing in prevention while diverting resources from unnecessary services will be key in promoting health. V-BID in exchanges, in conjunction with other payment reforms, may be the key to quality improvement and cost containment.
 V-BID cited as an approach to address Medicare insolvencyAddressing 

A U.S. House subcommittee reviewed three suggestions to address the future solvency of the Medicare Program. Recommendations include combining Medicare parts A and B under a unified cost-sharing structure to reduce costs; instituting a cap on out-of-pocket spending to protect beneficiaries from medical bankruptcy; and incentivizing high-value care to engage patients and providers to seek and provide the most effective health care.  
Aligning high-value primary care: Opportunities for V-BIDAligning

In PCPCC's June report, several national policy organizations highlight V-BID principles of clinical nuance to align the priorities of payment reform, care delivery reform, and patient and consumer engagement in primary care and medical home settings. 
Specialty drugs, complication, and obesity drive employer health spendingSpecialty
A recent study from Truven Health Analytics concludes that preventive services related to chronic disease management, specialty drugs, and complications related to surgery and the ongoing obesity epidemic drive health care spending increases.  In response to rising out-of-pocket costs, recently enacted Delaware legislation limits patients' co-insurance or co-payment fees for certain prescription drugs to $150 per month for up to a 30-day supply.
Health incentive programs can backfire if they penalize the overweightHealth

Psychological Science released findings from three studies that examined employee perception of employers' wellness incentive "carrot" and "stick" policies. Researchers found that overweight employees view "stick" policies as a reflection of a company's negative attitude toward overweight employees and that participants with overweight bias were likely to choose stick policies despite higher cost to the company.
HSA-eligible HDHPs: Informed decision making and cost savingsHSA_eligible
A census released by America's health Insurance Plans (AHIP) reports that enrollment in HSA-eligible HDHP plans has more than tripled over the last six years. The full census indicatesthat the majority of enrollees have access to resources to make informed health care decisions.  Additionally, EBRI's  five-year study of HSA-eligible HDHPs demonstrates sustained pharmacy and laboratory savings, while raising concerns regarding the cost-related underuse of high-value services..   

MetLife's 11th annual study of employee benefit trends found that 61 percent of employees worry about meeting out-of-pocket medical costs that are not covered by health insurance while half of surveyed employers state that employee cost-sharing is an important benefit strategy. These concerns create a delicate balancing act as employers attempt to control benefits costs and maintain employee loyalty.

Clinical, economic outcomes linked to medication adherence Medical

A recent study published in the Annals of Emergency Medicine finds that disabled Medicare beneficiaries who report severe cost-related medication non-adherence were more likely to have at least 1 ED visit. Failure to take blood pressure-lowering medicines as directed greatly increases the risk of stroke and death in patients with high blood pressure,as reported by the European Heart Journal.

IOM report:  Decision-makers, not geography, key to Medicare payment reformDecision 
The Institute of Medicine Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care has released a new report examining regional differences in Medicare and commercial health care spending. The report recommends against adopting a geographically-based value index for Medicare payments because the majority of health care decisions are made at the provider or health care organization level, not by geographic units. V-BID Center Director, Mark Fendrick, MD, participated on the study panel.

Newly finalized CMS regulations give state Medicaid programs more flexibility to impose clinically nuanced cost-sharing. This development can enhance the use of high-value clinical services and reduce utilization of unnecessary and costly services while fostering consumer engagement and personal accountability. Read our July brief on V-BID's role in Medicaid.    
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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