Value-Based Insurance Design: A Potential Solution to Reduce Cost-related Non-adherence and Improve Outcomes for Individuals with Diabetes
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1 Value-Based Insurance Design: A Potential Solution to Reduce Cost-related Non-adherence and Improve Outcomes for Individuals with Diabetes A. Mark Fendrick, MD University of Michigan Center for Value-Based Insurance Design
2 Making Health Care Great Again ; ) Innovations to prevent and treat disease have led to impressive reductions in morbidity and mortality Irrespective of these advances, cutting health care spending is the main focus of reform discussions Underutilization of high-value services persists across the entire spectrum of clinical care Our ability to deliver high-quality health care lags behind the rapid pace of scientific innovation
3 Star Wars Science
4 Flintstones Delivery
5 Moving from the Stone Age to the Space Age: Change the discussion from How much to How well Three-quarters of Americans say that our country doesn t get good value for what it spends on healthcare Moving from a volume driven to value based system requires a change in both how we pay for care and how we engage consumers to seek care Policy deliberations focus primarily on alternative payment and pricing models Consumer engagement is an essential and important lever to enhance efficiency Consumer cost-sharing is a common policy lever
6 Consumer Cost-Sharing: Paying More for ALL Care Regardless of Value Impact of Consumer Cost-sharing Deductibles Co-insurance Co-payments
7 Inspiration I can t believe you had to spend a million dollars to show that if you make people pay more for something, they will buy less of it. - Barbara Fendrick (my mother)
8 Impact of Cost-Sharing on Health Care Disparities Rising copayments worsen disparities and adversely affect health, particularly among economically vulnerable individuals and those with chronic conditions Chernew M. J Gen Intern Med 23(8):
9 Many Americans Make Healthcare Decisions Based on Cost 9
10 One in Four Patients Have Difficulty Affording Their Prescription Medicines
11 Flintstones Delivery
12 Americans Do Not Care About Health Care Costs; They Care About What It Costs Them 12
13 Clinical Nuance: An Alternative to Blunt Cost-Sharing The clinical value of a specific clinical service depends on: Who receives it? When in the course of disease? By whom? Where it is provided?
14 Implementing Clinical Nuance: Value-Based Insurance Design (V-BID) Value-Based Insurance Design Sets consumer cost-sharing on clinical benefit not price 14
15 V-BID: Bipartisan Political and Broad Multi- Stakeholder Support HHS National Governor s Assoc. CBO US Chamber of Commerce SEIU Bipartisan Policy Center MedPAC Kaiser Family Foundation Brookings Institution American Benefits Council Commonwealth Fund National Coalition on Health Care NBCH Urban Institute American Fed Teachers RWJF Families USA IOM AHIP Smarter Health Care Coalition AARP PhRMA DOD EBRI BCBSA AMA 15
16 Putting Innovation into Action: Translating Research into Policy Translating Research into Policy
17 ACA Sec 2713: Selected Preventive Services be Provided without Cost-Sharing Receiving an A or B rating from the United States Preventive Services Taskforce (USPSTF) Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) Preventive care and screenings supported by the Health Resources and Services Administration (HRSA) Over 137 million Americans have received expanded coverage of preventive services; over 76 million have accessed without cost-sharing 17
18 Putting Innovation into Action: Translating Research into Policy Translating Research into Policy
19 More Than One-Third of Medicare Beneficiaries Spent 20% or More of Their Income on Out-of-Pocket Costs in 2013
20 MA V-BID 1 st CMS Demonstration Allowing Cost-Sharing Reductions for Individuals with Specific Clinical Conditions 2018 Budget Expands MA V-BID Model Test to all 50 States by 2020
21
22 Putting Innovation into Action: Translating Research into Policy Translating Research into Policy HSA QUALIFIED HDHPS
23 IRS Rules Prohibit Coverage of Chronic Disease Care Until HSA-HDHP Deductible is Met PREVENTIVE CARE COVERED Dollar one CHRONIC DISEASE CARE NOT covered until deductible is met
24 Chronic Disease Management Act of
25 My Hope for the Future
Value-Based Insurance Design. A. Mark Fendrick, MD University of Michigan Center for.
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Improving Consumers Access to High-Value Health Care Shifting the discussion from How much to How well
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