Perspectives in value-based insurance design for patients with diabetes: assessment and application.

BACKGROUND: Value-based insurance design initiatives have been developed in an effort to reduce long-term healthcare costs and improve health quality. Value-based insurance design promotes the use of services or therapies that have been shown to have clinical benefits that outweigh the cost, such as encouraging medication adherence, and discourages those that produce results that do not justify the cost.
OBJECTIVE: The goal of this analysis is to determine the impact of value-based insurance design as it relates specifically to drug therapy, including adherence, for patients with diabetes.
METHOD: This article analyzes data collected by Milliman, a large actuarial group, using MedStat claims, National Health and Nutrition Examination Surveys, and its own 2008 health cost guidelines to develop an actuarial assessment of value-based insurance design programs for diabetes care and therapy. This assessment models the impact that copay structures and other management techniques have on adherence and incremental costs. The model provides a framework for assessing the value of benefits and directs patients toward cost-effective services supported by strong evidence-based medicine. DISCUSSION: Analysis of actuarial modeling shows that adjusting patient copayment designs is in line with other value-based approaches designed to improve patient care and reduce long-term costs. Evidence from value-based insurance design initiatives suggests that reducing patient copayment has the potential to improve clinical outcomes, including medication adherence, and reduce overall healthcare costs.
CONCLUSION: This analysis, coupled with results from other value-based insurance design initiatives and related research, provides support for employers and health insurance plans to consider adopting value-based insurance design programs for patients with diabetes to improve quality of care, while potentially reducing healthcare costs.