Value-Based Insurance Design. A. Mark Fendrick, MD University of Michigan Center for.

Transcription

1 Value-Based Insurance Design A. Mark Fendrick, MD University of Michigan Center for Value-Based Insurance Design

2 Outline Impact of Consumer Cost-sharing Clinical Nuance Value-Based Insurance Design Translating Research into Policy Low Value Care Aligning Provider and Consumer Incentives

3 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 growth is a 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

4 Star Wars Science

5 Flintstones Delivery

6 Getting to Health Care Value Shifting the discussion from How much to How well 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 Much of the deliberations is on alternative payment and pricing models Consumer engagement is an essential and important lever to enhance efficiency Consumer cost-sharing is a common and important policy lever

7 Consumer Cost Sharing: Deductible Spending has Risen while Copayment Spending has Fallen Getting to Health Care Value Shifting the discussion from How much to How well deductibles co-insurance co-payments

8 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

9 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):

10 1 in 4 People Taking Rx Drugs Report Difficulty Affording Their Medicine Very Easy 45% Very Difficult 9% Don t Have to Pay 1% Somewhat Easy 28% Somewhat Difficult 17%

11 Americans Do Not Care About Health Care Costs; They Care About What It Costs Them 11

12 An Alternative to Blunt Cost-Shifting Strategies: Clinically Nuanced Cost-Sharing A smarter cost-sharing approach that encourages consumers to use more high value services and providers, but discourages the use of low value ones 12

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14 Clinical Nuance: Key Takeaway

15 Potential Solution to Cost Related Non-Adherence of Essential Services: Value-Based Insurance Design (V-BID) Sets consumer cost-sharing level on clinical benefit not acquisition price of the service Successfully implemented by hundreds of public and private payers 15

16 V-BID: Bipartisan Political and Broad Multi- Stakeholder Support HHS CBO SEIU MedPAC Brookings Institution Commonwealth Fund NBCH American Fed Teachers Families USA AHIP AARP DOD BCBSA National Governor s Assoc. US Chamber of Commerce Bipartisan Policy Center Kaiser Family Foundation American Benefits Council National Coalition on Health Care Urban Institute RWJF IOM Smarter Health Care Coalition PhRMA EBRI 16

17 Putting Innovation into Action: Translating Research into Policy Patient Protection and Affordable Care Act Medicare TRICARE HSA-qualified HDHPs 17

18 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 18

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20 Putting Innovation into Action: Translating Research into Policy Patient Protection and Affordable Care Act Medicare TRICARE HSA-qualified HDHPs 20

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23 Bipartisan, Bicameral Legislation to Expand of MA VBID Demonstration to all 50 States

24 Putting Innovation into Action: Translating Research into Policy Patient Protection and Affordable Care Act Medicare TRICARE HSA-qualified HDHPs 24

25 Putting Innovation into into Action: Action: Translating Research into into Policy Policy Patient Protection and Affordable Care Act Medicare TRICARE HSA-qualified HDHPs 25

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31 DRAFT 6. Internal Revenue Service. The Commissioner of the Internal Revenue Service shall update the preventive care safe harbor under Section 223(c)(2)(C) of the Internal Revenue Code to include services or benefits, including medications, intended to prevent chronic disease progression or complications, for the purpose of helping patients adhere to clinical regimens and thereby reducing costs of healthcare.

32 Many Additional Reform Initiatives Include V-BID Alexander Murray Stabilization Bill Bipartisan Policy Center Kasich Bipartisan Governors Blueprint Center for Medicare and Medicaid Innovation (CMMI) HHS 2018 Notice for Benefit and Payment

33 Identifying and Removing Unnecessary Care Create Headroom to Buy High Value Services Discouraging the use of specific low-value services must be part of the strategy to enhance efficiency It is counter-intuitive to impose high levels of costsharing on those services that are identified as health plan quality measures Thus, instead of imposing blunt cost-sharing on all services, consider high cost sharing on only those services that do not make people healthier Savings from waste elimination are immediate and substantial

34 Multi-Stakeholder Task Force Identifies 5 Commonly Overused Services Ready for Action 1. Diagnostic Testing and Imaging Prior to Surgery 2. Vitamin D Screening 3. PSA Screening in Men Imaging in First 6 Weeks of Low Back Pain 5. Branded Drugs When Identical Generics Are Available

35 Aligning Payer and Consumer Incentives: As Easy as Peanut Butter and Jelly Many supply side initiatives are restructuring provider incentives to move from volume to value: Medical Homes Electronic Medical Records Accountable Care Organizations Bundled Payments/Reference Pricing Global Budgets High Performing Networks

36 Aligning Payer and Consumer Incentives: As Easy as Peanut Butter and Jelly Unfortunately, some demand-side initiatives including consumer cost sharing - discourage consumers from pursuing the Triple Aim

37 Aligning Payer and Consumer Incentives: As Easy as PB & J The alignment of clinically nuanced, providerfacing and consumer engagement initiatives is a necessary and critical step to improve quality of care, enhance patient experience, and contain cost growth

38 Discussion