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VBID Summit Explores How Congress Can Make High-Deductible Plans Work for Consumers

Mary Caffrey
Congress may be divided over the fate of the Affordable Care Act (ACA), but there’s another healthcare idea with bipartisan support that might see more movement before the end of 2017: value-based insurance design (VBID).

The concept of VBID, which seeks to remove financial barriers to high-value care, has been around for some time, having been pioneered by A. Mark Frederick, MD, of the University of Michigan and its Center for Value-Based Insurance Design, and Michael E. Chernew, PhD, of Harvard Medical School, the co-editors-in-chief of The American Journal of Managed Care® (AJMC®).

VBID found its way into the ACA, which requires plans to cover preventive services that have at least a B rating by the US Preventive Services Task Force without cost sharing. VBID principles are reflected in initiatives of the Center for Medicare and Medicaid Innovation (CMMI).

But as Fendrick and other experts explained yesterday at the Fall 2017 Summit, “Engaging Consumers, Providers, and Payers for Future of Value-Based Insurance Design,” presented by the Smarter HealthCare Coalition in partnership with the University of Michigan V-BID Center, the increased popularity of high-deductible health plans (HDHPs) among employers demands a policy response, as consumers find themselves unable to afford necessary care because too few services and drugs meet the narrow definition of “preventive” under current Internal Revenue Service rules.

Whether it’s through action from Congress or administrative changes by Medicare or the Treasury Department, a second wave of change is needed to connect coverage to high-value care, promote care coordination, and pave the way for patients to afford high-tech medicine coming from advances like DNA sequencing. Without legislative and regulatory changes, Fendrick said, Americans face a future of “Star Wars science with Flintstones delivery.”

“I did not go to medical school to learn how to save people money,” Fendrick said, noting that nearly all the conversations about healthcare in Washington, DC, aren’t about making people well but about cutting costs. “We have to change the conversation from how much we spend to how well we spend.”

The Summit, held atop the Hart Senate Office Building overlooking the Capitol Dome, allowed attendees to hear directly from staff members and a member of Congress involved in crafting the language that could let VBID catch the year-end wave of activity in Congress. Even while the summit unfolded yesterday, the Congressional Budget Office released its score for the bipartisan Alexander-Murray legislation to stabilize the individual market, which contains language encouraging VBID activity in the states.

While VBID may not be making the headlines, there’s plenty happening, and more should be, according to Representative Earl Blumenauer, D-Oregon. No matter what a member of Congress thinks of Obamacare, he said, figuring out how to direct resources toward high-value care is a conversation worth having. “In fact, where you are on that continuum makes it more important to have this conversation."

Throughout the day, current and former Congressional staff said VBID was the one healthcare idea that appealed to both parties—Republicans liked the idea of rewarding solutions that work, and Democrats like the idea of ensuring that patients get care.

Partisan rancor over the ACA has been such that "We’ve lost sight that what we want to do is expand coverage and lower costs,” said Blumenauer. “Parts of this country deliver very high-quality care … VBID is one of the most powerful ways to reorient that discussion. It even makes sense to people in Congress.”

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