Transcript the File - NAHU Education Foundation

Value-based Insurance Design
Source: National Association of Health Underwriters Education Foundation
1
A New Approach to Benefits: Recognize Clinical Nuance
University of Michigan Center for Value-Based Insurance Design
Source: National Association of Health Underwriters Education Foundation
2
Value-based Insurance Design
‣
Sets consumer cost-sharing
level on clinical
‣
‣
Reduce or eliminate financial
barriers to high-value clinical
services and providers
Successfully implemented
by hundreds of public
and private payers
University of Michigan Center for Value-Based Insurance Design
Source: National Association of Health Underwriters Education Foundation
3
Example: Waiving Co-Pays for Medications after a Heart Attack
‣
Study assessed impact of free
access to preventive medications for
Aetna members who had a heart
attack
‣
Random trial reported in New
England Journal of Medicine
‣
“Enhanced prescription coverage
improved medication adherence and
rates of (heart attacks) and
decreased patient spending without
increasing overall health costs.”
Source: National Association of Health Underwriters Education Foundation
4
Implementing V-BID: Connecticut State Employees Health Plan
‣
‣
Participating employees receive a reprieve from
higher premiums if they commit to:
‣
Yearly physicals, age-appropriate screenings/preventive care,
two free dental cleanings
‣
Employees with certain chronic conditions must participate in
disease management programs (which include free office visits
and lower drug co-pays)
Early results:
‣
99% of employees enrolled
‣
Decrease in ER and specialty care
‣
Increase in primary care visits
‣
Increase in chronic disease medication adherence
‣
Medical spending trend declined
Source: National Association of Health Underwriters Education Foundation
5
Steering Employees to Centers of Excellence
‣
Lowe's eliminates co-pays and pays
travel costs if employees use the
Cleveland Clinic for elective heart
procedures
‣
Cleveland Clinic’s negotiated bundled
price beats price of local hospitals
Source: National Association of Health Underwriters Education Foundation
6
HSA-qualified HDHPs: Making Them Work for the Chronically Ill
‣
More than 25% of employers now offer High
Deductible Health Plans, many with qualified
Health Savings Accounts
‣
The clinical downside: Higher out-of-pocket
costs may discourage employees from
getting evidence-based medical services
‣
The upshot: There is a movement to
changes the rules to encourage enrollees
with chronic diseases to get the care they
need to manage their conditions
Graphic: Western Health Advantage
Source: National Association of Health Underwriters Education Foundation
7