VBID Gathers Steam

According to Health Care Payer News, value-based insurance design (VBID) is starting to gain traction among large employers. Large self-insured employers like Marriott and Pitney Bowes have started incorporating VBID into their benefit packages, and public employee plans in seven states, including Oregon, Connecticut, Minnesota and Tennessee, have as well — mostly with union support.

For example, Connecticut, trying to address a $3.5 billion deficit, implemented a VBID plan for public employees in 2011. Employees had the option of staying in a PPO — with $100 more in premiums per month, plus a $3,500 deductible — or enrolling in a no-deductible VBID plan that includes a health risk assessment and participation in chronic disease management programs for those with the conditions.  Now, 98 percent of the beneficiaries are enrolled in the VBID program, and while the Connecticut comptroller “can’t say he’s saving money, it’s neutral,” says Dr. Mark Fendrick, director of the VBID Center at the University of Michigan.

Also, for the first time, the Centers for Medicare & Medicare Services is allowing value-based designs in Medicaid, with clinically nuanced cost-sharing for drugs, ER visits, and hospitalizations. But VBID has a ways to go before it's considered mainstream. Estimates indicate that non-clinically-nuanced high-deductible health plans are about 30 percent more prevalent than VBID, and there are still obstacles — both in perception and policy.

Aetna had a VBID medication program for heart attack patients, offering four drugs shown to help prevent second attacks for free — and the rate of adherence increased only from 42 to 49 percent. Another obstacle to VBID is the Internal Revenue Services’ regulations on health savings accounts.