Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.
A panel of experts provided consumer insights into value-based insurance design (VBID) and how the COVID-19 pandemic may have changed consumer behaviors in a way that VBID may be able to address as the country emerges from the pandemic.
Consumers, regardless of political ideology or where they live in the United States, are concerned about the affordability of health care for themselves, their family, and even their neighbor. Value-based insurance design (VBID) is an important tool to address the health care affordability issue, said Frederick Isasi, executive director, Families USA, during the third session of the V-BID Summit 2021, hosted by the Center for Value-Based Insurance Design at the University of Michigan.
Isasi was joined by Jill Berger, director of employer and payor relations, Leapfrog Group; John Rother, president, National Coalition on Health Care; and Marge Ginsburg, BSN, MPH, retired, founding executive director, Center for Healthcare Decisions, Inc, for a panel providing consumer insights into VBID.
As the country emerges from the COVID-19 pandemic, consumer health care behavior may look a little different than it has in the past. Isasi noted that there is a lot of pent-up demand for care “that is going to be unleashed post pandemic as people held back on seeking out care for key issues they thought could wait.”
Berger added that the way employers seek to provide care is changing as a result of the pandemic. Some large employers have utilized Centers of Excellence in the past and would fly people out to be diagnosed or have their treatment evaluated, but the ability to fly across the country was curtailed during the pandemic. The result is that employers are putting more focus on identifying providers locally. In areas where hospitals need to improve patient safety, employers may be able to push them to make needed changes.
She also agreed with Isasi’s identification of pent-up demand for care. “A lot of elective surgeries have been put off, and there is going to be greater demand for these services.”
During the last year, the pandemic has helped to reveal serious issues around health equity, consumer education, and health care, said Rother.
“The fact that we have so many people who are refusing to get vaccinated is a big reminder that even the most basic high-value services aren’t always well understood or acted upon in the population,” he said. Rother added, “It seems we’ve got a bigger job than maybe we realized in terms of health communication and motivating appropriate behavior.”
However, Ginsburg said she hasn’t seen a lot of change in the priorities people have, which tend to be: what is it going to cost me? What are the limitations on the providers I want to see? What tradeoffs will I have to take into account?
One interesting area for her is telehealth, which can be pursued with more depth by VBID. She admittedly has been viewing telehealth with a bit of skepticism because she tends to look at new ways of delivering health care and trying to determine how it could go wrong.
“Is telehealth high-value care or low-value care?” Ginsburg asked. “In the pandemic, it’s definitely high value. Outside of the pandemic? I don’t think we know yet.”
The panel then discussed how they felt VBID could be implemented better in the current consumer environment, and Isasi described VBID as an economic armor for consumers. He explained that typically providers tell policy makers that they just want to do what is best for the patient, but the reality is physicians are responding to fee-for-service economics, which he doesn’t view as being in the best interest of patients.
VBID provides protection for consumers who don’t have the ability review peer-review research to make the best decisions about a service or a drug. VBID is “armor for them to make the best choices,” Isasi said.
Rother added that new language is needed. While many in the health care sector may understand what is meant by value, “I would posit that most regular people don’t.”
He suggested that using the term “waste” would be more impactful. “Wasteful health care spending has a huge systematic impact on the people.”
In addition to a change in language, more work is needed to change physician behavior. Rother pointed to the billions of dollars that go to brand name drugs when less expensive, equally effective generics are available.
“We’ve got to get physicians in the game and to do that we need to move away from fee-for-service,” Rother said.