Healthcare reform is encouraging a lot of experimentation with health insurance, particularly as payers try to reduce healthcare costs, particularly among patients with chronic conditions. A new study led by West Health Policy Center, with researchers from Harvard University Medical School and the University of Michigan Center for Value-Based Insurance Design, will explore the feasibility of one health insurance innovation that’s been getting more support among policy centers: value-based insurance design.
The study will determine whether insurance plans can be tailored to people with chronic conditions such as diabetes and cardiovascular disease with an eye to tests and treatments that reduce costs for insurers and members, according to a company statement. Depending on the findings, it could have ramifications for Medicare and Medicaid.
Among some of the challenges of enrolling in high deductible plans for chronically ill people are higher out-of-pocket costs for essential treatment such as blood pressure and cholesterol checks, medication, eye and foot exams, and glucose monitoring supplies until the deductible is reached. The idea behind “value-based insurance” is that it would modify costs associated with their chronic condition and increase costs for non-related care, such as treatment for a bone fracture.
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The study will develop and price hypothetical high deductible health plans that use V-BID principles and estimate the potential impact on enrollment in those plans by people with chronic conditions, according to the statement.
It could also improve patient engagement as people would be more likely to seek care for their chronic conditions if they could better manage those costs:
Modifying a high deductible plan to lower the patient’s out-of-pocket cost for clinically recommended diabetes treatment services has the potential to reduce health complications and overall spending. Maintaining the deductible structure for medical goods and services not affiliated with diabetes management will continue to motivate employees and their families to research and seek high-quality, necessary care.
Controlling medical costs is a big priority, particularly for Medicare and Medicaid patients. Medicare enrollees tend to have chronic illnesses; 85 percent have at least one and 50 percent have three or more, with many taking between five and seven prescription medications.
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Diabetes, for example, accounted for $176 billion in healthcare costs in 2012, according to the American Diabetes Association.
One of the problems that I can envision with this approach is the inevitable gray area. What if a diabetes patient broke an arm because his or her blood sugar was low? It will be interesting to see the study results, which the organizers are expecting to have in the second quarter of this year.
