Evidence accumulates for Value-Based Insurance Design:

Adherence improvements enhanced by plan characteristics

The basic premise of Value-Based Insurance Design (V-BID) is to align consumer incentives with value by reducing barriers to high-value health services and providers ("carrots"). When "carrots" are used in a clinically nuanced manner, V-BID improves health care quality and controls spending growth. The concept of clinical nuance recognizes that: 1) medical services differ in the benefit provided; and 2) the clinical benefit derived from a specific service depends on the patient using it, as well as when and where the service is provided.

Recent evaluations add to the published evidence that clinically nuanced copayment reductions lead to improvements in medication adherence. A 2014 Journal of Managed Care Pharmacy study reported that copay reductions for Medicare beneficiaries prescribed statins resulted in a 5.9% increase in adherence over 6 months compared to those paying standard copayments.¹ A second 2014 JMCP study found a 4.9% increase in adherence among commercially insured individuals enrolled in a $0 copayment program for generic anti-diabetic and anti-hyperlipidemic medications.²

An evaluation of a Blue Cross Blue Shield of North Carolina V-BID program that eliminated copayments for generic hypertension medications and lowered copays for brand-name medications saw an adherence increase of 2.7-3.4% over a two-year period. Total non-medication expenditures for the study population decreased $5.7 million, offsetting 80% of the added $6.4 million spent on medications.³

The fact that the untargeted North Carolina V-BID program approached cost neutrality in only two years raised the question, 'Which V-BID characteristics produce the most impact?' In a recent Health Affairs evaluation of 76 V-BID plans, Choudhry and colleagues reported programs that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features.⁴

Momentum for V-BID continues to grow among private payers, state employee plans and in the Medicaid and Medicare programs. Accumulating evidence on V-BID's clinical and economic impact and the identification of plan characteristics that predict program success can shape future public and private V-BID programs that both improve quality and contain cost growth.

[1]http://amcp.org/JMCP/2014/January/17493/1033.html

[2]http://amcp.org/JMCP/2014/February/17598/1033.html

[3]http://content.healthaffairs.org/content/33/2/300.abstract

[4]http://content.healthaffairs.org/content/early/2014/02/07/hlthaff.2013.0060

The University of Michigan Center for Value-Based Insurance Design leads in research, development, and advocacy for innovative health benefit plans.