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Improving Access to High-Value Care Lowers Costs, Improves Health


Published Aug 6, 2019 • by AHIP

Study: Advancing value-based insurance design principles for coverage options on the Exchange marketplace

We need greater value in health care for patients and consumers, ensuring the right care is delivered at the right time, and with greatest effectiveness. That’s where value-based insurance design (VBID) comes in – which promotes access to high-value care services for the best health results at the best price.

For example, a health plan may set no cost sharing for medications and doctor visits necessary to control chronic conditions, like diabetes, high blood pressure, and asthma – while raising deductibles and copays for services proven to be low-value, wasteful, or harmful.

By eliminating or reducing cost-sharing for high-value services, VBID holds promise in reducing financial barriers to needed medical care, improving adherence to prescribed treatments, and achieving better health outcomes. And, by targeting low-value and commonly overused services, it can also help reduce waste in the health care system, protect patient safety, and slow down health care cost growth.

Now, a new Health Affairs study spearheaded by researchers at the University of Michigan and Harvard Medical School seeks to apply the principles of value-based insurance design to the individual market, where consumers buy insurance coverage on their own. This would provide new benefit options for 15.2 million Americans and help reduce financial barriers to care and improve the quality and value of insurance coverage especially for millions of patients with chronic conditions.

Their solution is VBID-X: a new coverage option for the federal and state exchange marketplaces. VBID-X is a template, not a prescribed list of cost sharing and benefits, that health plans can adapt and use to best meet the needs of individuals and families.

AHIP joined state and federal regulators in an 18-month process to create this practical blueprint for using value-based insurance design principles for consumers who buy their own coverage. In doing so, the VBID-X model plans adhere to important benefit design principles:

  • flexibility in plan design and management;
  • focusing on targeted high-value services; and
  • addressing operational and administrative obstacles.

AHIP and our member plans have been strong supporters of this concept and value-based insurance design has been successfully adopted in other segments of the health insurance marketplace:

Working together with federal and state policymakers and other stakeholders, AHIP looks forward to facilitating greater value-based insurance designs in the exchange market and beyond.

Watch this webinar for more information.