Value-Based Benefits: Are We There Yet?

Last fall, HealthLeaders reported on two studies published in Health Affairs that reached similar conclusions regarding emerging value-based insurance design (VBID) programs: Lower member out-of-pocket costs for high-value chronic illness prescriptions encourages more faithful adherence to medication.

The somewhat more broadly defined value-based benefit design (VBBD) programs aim to pair a wide range of incentives—including cash—with member engagement in both high- and low-value activities, including a commitment to a healthier lifestyle via participation in wellness or disease management programs.

In theory, this will lead to improved long-term outcomes via lower utilization of high-value treatments. After all, according to results of the just-released HealthLeaders Media Industry Survey, 61% of healthcare leaders say overutilization of services is the top driver of healthcare costs.

But is it still just a theory? Theoretically, yes, as the concept is relatively new and lacks significant case-driven data given that conclusions are based on long-term results. But greater scientific evidence from predictive models detailing anticipated financial benefits may be stating the case for value-based programs loud and clear.

"Using plan designs and incentives to drive member engagement in high-value services can improve adherence, which ultimately leads to improved health status and long-term medical savings," said David Hom during a recent Webcast. Hom was a VBBD pioneer at Pitney Bowes—regarded as the first large employer to embrace a value-based program—and is now president of the care management and wellness division of SCIOinspire, a provider of business process analytics that specializes in, among other things, helping its customers determine the effectiveness of their care management efforts.

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