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V-BID plays key role in Michigan Medicaid  expansionMI_Medicaid

Yesterday's 20-18 Senate vote made Michigan the 25th state in the nation to expand Medicaid under the Affordable Care Act. The new plan--Healthy Michigan--will provide coverage to an additional 470,000 residents over the next several years. Among the provisions of the Senate version of House Bill 4714, Healthy Michigan relies on Value-Based Insurance Design (V-BID) to improve access, control costs, and enhance personal responsibility. Section 105d(1)(e) permits health plans to waive copays "to promote greater access to services that prevent the progression and complications related to chronic diseases." Health plans may also reduce enrollee contributions for meeting certain healthy behavior goals or addressing unhealthy behaviors such as alcohol and tobacco use, substance use disorders, and obesity. Moreover, Section 105d(1)(f) of the new law explicitly calls for the creation of a clinically nuanced value-based design:  "By July 1, 2014, design and implement a copay structure that encourages the use of high-value services, while discouraging low-value services." The incorporation of V-BID into Healthy Michigan follows the recent CMS rule giving Medicaid programs greater flexibility to vary enrollee cost-sharing for drugs as well as certain outpatient, emergency department, and inpatient visits. When V-BID principles are used to set enrollee cost-sharing levels, Medicaid programs can improve quality of care, remove waste, foster consumer engagement, and mitigate the legitimate concern that non-nuanced cost-sharing may lead individuals to forgo clinically important care.

NYTNYT: When a Co-Pay gets in the way of health

In a recent New York Times article, Harvard economist Sendhil Mullainathan articulates strong support for clinically nuanced, value-based insurance design (V-BID) programs. Mullainathan highlights the well-documented problem of cost-related medication non-adherence and recommends that high-value drugs such as those that treat heart disease and diabetes be provided at no cost to the populations that need them.   

JAMA: No co-pays, easier pills, reduce blood pressureJAMA
A new JAMA study suggests that giving patients easier-to-take medicine and offering no-copay medical visits may help drive down high blood pressure--a major contributor to poor health and untimely deaths nationwide. In an eight year study involving more than 300,000 Kaiser Permanente patients with hypertension, a disease management program including guideline dissemination, free medical assistant visits, and simplified medication regimens led to nearly eighty percent of patients meeting blood pressure goals.
CHEST: Use V-BID to align incentives in pulmonary careCHEST
An article in CHEST authored by the V-BID Center supports the implementation of clinically nuanced principles in pulmonary medicine. The manuscript creates a framework for V-BID development in pulmonary medicine, and outlines how the concept aligns with research, care delivery, and payment reform initiatives.
Employee engagement program saves UnitedHealth $107MUNITED

Over three years, UnitedHealth's Rewards for Health program, which awarded premium reductions to employees for meeting certain health goals, getting screenings, or losing weight, has saved UnitedHealth $107 million. The full Health Affairs article can be found here
New HCI3 report supports clinical nuance in payment reformHCI3

A new report from Health Care Incentives Improvement Institute and the Robert Wood Johnson Foundation contends that incentives and disincentives (carrots and sticks) must be applied with the clinical encounter in mind--not the cost--to both amplify the powerful internal motivations that doctors and patients have to improve health and to reform payment/delivery options.
BCBS Minnesota and Allina unveil "BluePrint" plan BLUEPRINT

Utilizing input from patients and employers, Blue Cross Blue Shield of Minnesota and Allina Health have created the BluePrint planwhich will be available on the state exchange. Select high-value services, such as office visits and those that manage certain chronic conditions (e.g. diabetes, hypertension, and high cholesterol), are available at low or no cost when members visit specific high-performing providers. 

Health Affairs: HDHPs reduce high severity ER use HDHP 


To assess utilization trends, researchers analyzed emergency department visits and hospitalizations over two years among enrollees insured in high-deductible plans. Results for plan members of low socioeconomic status showed 25-30% reductions in ED visits over both years. Hospitalizations also declined by 23% during year 1, but year 2 showed an increase in hospital stays. These results suggest that low socioeconomic plan members at small firms responded inappropriately to high-deductible plans and that initial reductions in high-severity ED visits might have increased the need for subsequent hospitalizations. Read more about unanticipated HDHP costs.

CMS Approves Medicaid Preventive Coverage ExpansionCMS

CMS approved Medicaid state plan amendments from Nevada, New Hampshire, and New York to cover additional USPSTF-approved preventive services. These states will receive an increase in federal funding to provide these services. 

Majority of California voters note increased health care costCALI


Results from The Field Poll sponsored by the California Wellness Foundation show that nearly half of California voters say that their health care costs have increased and are difficult to afford, while 47% report no difficulty in affording care. Additionally, nearly 75% of respondents note that California's Medicare program successfully meets its goals, and 66% of respondents say that California Medicaid is also effective. 

The University of Michigan Center for Value-Based Insurance Design (V-BID)
leads in research, development and advocacy for innovative health benefit designs.

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