VBID, Heading Into a Third Decade, Looks to Promote Personalization and Access

The integration of value-based insurance design (VBID) into health policy started so long ago that a seminal research paper¹ was faxed to a congressional staffer searching for a health care reform idea, according to that staffer, Andrew Chasin, JD, now the vice president of federal policy and advocacy at Blue Shield of California. Twenty years later, the implementation of VBID has evolved from encouraging more use of high-value services to also discouraging use of low-value services, and it is poised to become more personalized in the coming years.

These memories and predictions were shared by Chasin and fellow panelists Adam Beck, MS, JD, senior vice president of product, employer, and commercial policy at AHIP, and Silas Martin, MS, head of access and policy research at Johnson & Johnson, during a session of the University of Michigan Center for Value-Based Insurance Design’s 2025 V-BID Summit. The speakers discussed how VBID principles have impacted their organizations and the broader health care ecosystem as part of the pursuit of value, access, and quality.

The lessons of that fateful fax, detailing how an employer saw decreased diabetes costs for its employees after lowering acquisition costs for generic diabetes drugs, represented the first iteration of VBID, or VBID 1.0. As health care costs spiraled upward out of control, according to Chasin, VBID evolved to include discouraging the use of low-value services, like routine vitamin D testing, so those savings can be used to pay for the more beneficial services.

Insurers’ perceptions of VBID have also evolved, according to Beck, as they are now running toward it with enthusiasm and collaborating with other stakeholders. An example is the creation of a value-based care payment playbook by AHIP, the American Medical Association, and the National Association of Accountable Care Organizations.² Initiatives like these have led to “real-life successes in people’s lives, people who have medications today that they may not have had had these principles not been embraced so widely,” Beck said.

The preventive care services mandate in the Affordable Care Act is an example of a VBID-influenced policy that has become enormously popular and even defended adamantly by the health insurance industry amid threats to its legality,³ Chasin added. “You’ve seen the industry really align behind defending access to those services at zero cost, because they’re both the right thing to do for our members and the most popular item in the Affordable Care Act,” he said. “I think that really demonstrates how VBID has been really accepted as a standard.”

Shaping a standard begins with generating evidence and measuring quality, which eventually builds up to a change in policy, Martin said. From his perspective at a drug manufacturer, this could include looking to see how certain drugs affect quality metrics and fill unmet needs, which can then inform patients’ benefit designs.

Just as important as setting policy is remaining nimble, Beck added: “If VBID is being adopted by plans across the country, but patients aren’t seeing any difference, we need to reevaluate whether or not we’re taking the right approach.” It’s also necessary to address the cracks in the system that may be exposed by VBID, such as insufficient access to primary care, Chasin said.

VBID’s progress and impact to date can be attributed to its common-sense nature and bipartisan support, the panelists agreed. “High-efficiency, high-value care is actually an investment in an ecosystem, actually in productivity and society,” Martin summarized.

Looking forward, Beck suggested that provider buy-in and patient knowledge of VBID need to grow for its continued evolution. Chasin added the necessity of building on personalized VBID, because the same service that’s high value for one person can be low value for another. Finally, Martin emphasized the importance of setting realistic expectations for VBID; these efforts may not always save money, if high-value care is being used in place of low-value care, but they should help get closer to the ideal of paying for the right care for the right patient at the right time.

References

1. Mahoney JJ. Reducing patient drug acquisition costs can lower diabetes health claims. Am J Manag Care. 2005 Aug;11(suppl 5):S170-S176.
2. AHIP; American Medical Association; National Association of Accountable Care Organizations. A Playbook of Voluntary Best Practices for VBC Payment Arrangements. American Medical Association; 2024. Accessed March 12, 2025. https://www.ama-assn.org/system/files/vbc-best-practices-playbook.pdf
3. Bonavitacola J. Braidwood case headed to Supreme Court, preventive care in jeopardy. AJMC. February 4, 2025. Accessed March 12, 2025. https://www.ajmc.com/view/braidwood-case-headed-to-supreme-court-coverage-for-preventive-care-in-jeopardy