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Dr. Allison Rosen presents Redesigning Health Insurance to Change Behavior as an invited panelist at the American Diabetes Association Annual Meeting in Philadelphia, PA on June 9, 2012.
High copays and increased patient cost sharing decrease the use of preventative medicine and worsen socioeconomic disparities in healthcare utilization. Value-based insurance design (VBID) is being purported as an innovative approach to health care financing that increases utilization of high-value health care services while reducing that of low-value services. Dr. Rosen discusses the merits of VBID during her presentation Redesigning Health Insurance to Change Behavior.
The question that always comes up, according to Dr. Rosen, is whether VBID saves money; however, the more appropriate question is whether VBID improves patient outcomes (or health returns) relative to every dollar spent. For VBID to save money, the cost of increased utilization of high-value services can be subsidized by medical cost offsets, enhanced productivity, decreased disability costs, and higher cost sharing for services of lower value. Dr. Rosen suggests that return on investment can be maximized by strategic targeting. For example, return on investment for measures that prevent adverse events will be greater if they are targeted to those most likely to have an event rather than the general population.
Evidence shows that as barriers to quality health care decrease, utilization increases. Those increases are modest,admits Dr. Rosen, in the range of 1%-7%, and their clinical significance has yet to be determined. However, she noted, “If you are getting some increases, at least you are not spending the money on other services that are getting you nothing or perhaps decreasing health.” To date most private-sector VBID programs have focused on removing barriers to evidence-based services for chronic disease. There is a growing recognition, though, that improving value in health care will require increasing barriers to low value services as well.