This article was collaboratively written by A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design (V-BID), and several V-BID Center staff.
A literature review
in Health Affairs
describing the impact of a value-based insurance design (VBID) model on medication adherence and overall cost found that VBID programs reduce consumer cost-sharing for clinically indicated medications and increased medication adherence at no net change in total spending. This suggests that increases in pharmaceutical spending by plans were offset by decreases in spending for other healthcare services, such as emergency department visits or hospital stays.
The review included studies that compared a traditional prescription drug plan with a VBID plan that reduced copayments or coinsurance rates for select high-value services, focusing on treatments for specified chronic diseases for which a generic medication option was available. The 796 studies included in the review, with very few exceptions, showed significant improvement in medication adherence for at least 1 drug class under a VBID model. Of the 9 studies that evaluated healthcare spending, all measured a decrease or no net change in total spending.
The authors, which included A. Mark Fendrick, MD, the co-editor-in-chief of The American Journal of Managed Care®
and the director of the V-BID Center, noted that there are no published controlled studies on VBID programs that limit the use of low-value services through increased consumer cost-sharing. Reducing the use of low-value services would provide immediate and substantial savings, creating headroom to lower cost-sharing for high-value services. Thus, the authors predict that VBID that limits low-value care would ultimately save cost.
Most of the present literature on VBID focuses on its application to prescription drugs. However, there are limited data that report on healthcare quality and patient-centered outcomes. The researchers suggest that future studies on VBID focus on factors that further enhance medication adherence and downstream patient-centered outcomes, as well as address common clinical conditions such as mental health disorders, opioid abuse, and musculoskeletal conditions.
Agarwal R, Gupta A, Fendrick AM. Value-based insurance design improves medication adherence without an increase in total health care spending. Health Aff (Millwood)
. 2018;37(7):1057-1064. doi: 10.1377/hlthaff.2017.1633.