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Value-Based Benefits: Are We There Yet?

Jeff Elliott for HealthLeaders Media, February 16, 2011

By any name, value-based health insurance programs are gaining traction as employers look to control their healthcare costs.

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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1 comments on "Value-Based Benefits: Are We There Yet?"


Jerry Scherer (2/17/2011 at 10:56 AM)
Monitoring and measuring ongoing compliance is vital. Advances in mobile health monitoring services that are integrated with a PHR are essential components that support value-based and other health benefits.