Value-Based Insurance Design


Clinical nuance is one of the core tenets of value-based insurance design, which is one possible solution to alleviate the financial burden Americans face as they are asked to pay a greater percentage of their healthcare expenditures.
In current Medicare benefit designs, out-of-pocket costs do not reflect the expected clinical benefit or value of care. Research indicates that increasing patient cost sharing not only reduces the use of non-essential care, but also reduces the utilization of essential care.
The use of low-value care and the associated cost is a significant concern in the US healthcare system. However, solutions to measure, identify, and eliminate low-value care are challenging and complex.
Both private and public healthcare plans have traditionally used patient cost sharing to keep costs down. However, implementing value-based insurance design may be able to promote efficiency while increasing the use of high-quality care.
There are desirable and undesirable effects of high-deductible health plans, and the use of value-based insurance design may mitigate adverse effects of these plans, explained Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.


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