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The American Journal of Managed Care May 2019
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Evaluation of Value-Based Insurance Design for Primary Care
Qinli Ma, PhD; Gosia Sylwestrzak, MA; Manish Oza, MD; Lorraine Garneau; and Andrea R. DeVries, PhD
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Evaluation of Value-Based Insurance Design for Primary Care

Qinli Ma, PhD; Gosia Sylwestrzak, MA; Manish Oza, MD; Lorraine Garneau; and Andrea R. DeVries, PhD
The removal of cost sharing increased primary care access and did not negatively affect total cost of care.

Objectives: To evaluate the impact of value-based insurance design (VBID), which removed patient cost sharing for primary care visits, on healthcare spending in a large, geographically diverse employer.

Study Design: Quasi-experimental, difference-in-differences (DID) design, administrative claims–based study.

Methods: Healthcare spending during the preintervention period (2008 and 2009) was compared with the postintervention period (2011 through 2014) to measure the impact of removing primary care cost sharing. The study population included Anthem commercially insured enrollees with continuous medical eligibility from 2008 to 2014 who were younger than 65 years. The VBID cohort included health plan enrollees from a national large employer that implemented the benefit change. The comparison cohort included other Anthem enrollees who did not have a similar benefit change and were propensity score–matched to the VBID cohort. Utilization of various types of healthcare services was also examined.

Results: The VBID cohort experienced a $12.0 per member per month relative reduction in overall spending compared with the comparison cohort (P = .02). The trend was driven by reductions in expenditures for emergency department (ED) visits ($1.3 relative reduction; DID, –10.0%; P = .03) and other outpatient services ($7.6 relative reduction; DID, –5.8%; P = .02), which aligned with reduced utilization of ED visits (DID, –4.5%; P = .07) and other outpatient services (DID, –4.1%; P = .004). For physician office visits, the VBID cohort did not experience a significant relative increase compared with the comparison cohort (DID, 0.9%; P = .25).

Conclusions: The attempt to increase primary care access by reducing cost sharing did not produce a negative outcome in terms of total spending for healthcare.

Am J Manag Care. 2019;25(5):221-227

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