Value-based insurance design

Health Affairs

Volumn 26, Issue 2, 2007, Pages

  Chernew, Michael E ^a   Rosen, Allison B ^b   Fendrick, A Mark ^c  

^a HARVARD MEDICAL SCHOOL   (United States)

^b UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

^c Department of Internal Medicine ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST; COST BENEFIT ANALYSIS; GOVERNMENT; HEALTH CARE COST; HEALTH INSURANCE; HUMAN; INSURANCE; NATIONAL HEALTH INSURANCE; ORGANIZATION; ORGANIZATION AND MANAGEMENT; UNITED STATES;

COST SHARING; COST-BENEFIT ANALYSIS; FEDERAL GOVERNMENT; HEALTH EXPENDITURES; HUMANS; INSURANCE BENEFITS; INSURANCE CLAIM REVIEW; INSURANCE, HEALTH; NATIONAL HEALTH INSURANCE, UNITED STATES; ORGANIZATIONAL INNOVATION; PRIVATE SECTOR; UNITED STATES; UNIVERSAL COVERAGE;

EID: 33947310898     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.2.w195     Document Type: Article

References (29)

1. J.P. Newhouse and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1994);
2. T.B. Gibson, R.J. Ozminkowski, and R.Z. Goetzel, "The Effects of Prescription Drug Cost Sharing: A Review of the Evidence," American Journal of Managed Care 11, no. 11 (2005): 730-740;
3. T. Rice and K.Y. Matsuoka, "The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors," Medical Care Research and Review 61, no. 4 (2004): 415-452;
4. M. Heisler et al., "The Health Effects of Restricting Prescription Medication Use because of Cost," Medical Care 42, no. 7 (2004): 626-634;
5. and A.L. Siu et al., "Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans," New England Journal of Medicine 315, no. 20 (1986): 1259-1266.
6. For example, Goldman and colleagues identify adverse effects of copayments when the average nonpreferred brand-name copayment increased from about $12 to about $20. D.P. Goldman et al., "Pharmacy Benefits and the Use of Drugs by the Chronically Ill," Journal of the American Medical Association 291, no. 19 (2004): 2344-2350.
7. The VBID concept was originally referred to as the "Benefit Based Co pay." See A.M. Fendrick et al., "A Benefit-Based Copay for Prescription Drugs: Patient Contribution Based on Total Benefits, Not Drug Acquisition Cost," American Journal of Managed Care 7, no. 9 (2001): 861-867.
8. A.M. Fendrick and M.E. Chernew, "Value Based Insurance Design: A 'Clinically Sensitive' Approach to Preserve Quality and Contain Costs," American Journal of Managed Care 12, no. 1 (2006): 18-20.
9. J.D. Kleinke, "Access versus Excess: Value-Based Cost Sharing for Prescription Drugs," Health Affairs 23, no. 1 (2004): 34-47;
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13. K. Arrow, "Uncertainty and the Welfare Economics of Medical Care," American Economic Review 53, no. 5 (1963): 941-973;
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15. M.V. Pauly, "The Economics of Moral Hazard," American Economic Review 58, no. 3 (1968): 531-537.
16. Newhouse, "Reconsidering the Moral Hazard-Risk Avoidance Tradeoff."
17. Health plan designs are often created by self-insured employers. Therefore, much of the discussion of VBID relates to initiatives in plan designs driven by employers.
18. J.C. Robinson, "Consumer-Directed Health Insurance: The Next Generation," Health Affairs 24 (2005): w583-w590 (published online 13 December 2005; 10.1377/hlthaff.w5.583).
19. J.C. Robinson and J.M. Yegian, "Medical Management after Managed Care," Health Affairs 23 (2004): w269-w280 (published online 19 May 2004; 10.1377/hlthaff.w4.269).
20. R.A. Hayward et al., "Reporting Clinical Trial Results to Inform Providers, Payers, and Consumers," Health Affairs 24, no. 6 (2005): 1571-1581.
21. J.P. Newhouse and A.D. Sinaiko, "What We Know and Don't Know about the Effects of Cost Sharing on Demand for Medical Care-and So What?" (Paper presented at Health Economics Conference, Oberlin College, September 2006).
22. Michigan Healthy Community, "M-Healthy: Focus on Diabetes," 2005, http://www.umich.edu/~hraa/mhealthy/improve/diabetes.html (accessed 8 January 2007).
23. The program will be expanded to UM employees with ischemic heart disease once clinical and pharmacy data are linked to allow for real-time identification of patients with that condition.
24. A.B. Rosen et al., "Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Beneficiaries with Diabetes," Annals of Internal Medicine 143, no. 2 (2005): 89-99.
25. D.P. Goldman, G.F. Joyce, and P. Karaca-Mandic, "Varying Pharmacy Benefits with Clinical Status: The Case of Cholesterol-Lowering Therapy," American Journal of Managed Care 12, no. 1 (2006): 21-28.
26. S. Hensley, "From 'One Size Fits All' to Tailored Co-Payments," Wall Street Journal, 16 June 2004;
27. and J.J. Mahoney, "Reducing Patient Drug Acquisition Costs Can Lower Diabetes Health Claims," American Journal of Managed Care 11, no. 5 Supp. (2005): S170-S176.
28. C.W. Cranor, B.A. Bunting, and D.B. Christensen, "The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program," Journal of the American Pharmaceutical Association 43, no. 2 (2003): 173-184.
29. M.E. Chernew, A.B. Rosen, and A.M. Fendrick, "Rising Out-of-Pocket Costs in Disease Management Programs," American Journal of Managed Care 12, no. 3 (2006): 150-154.