Cargando…

What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors

Advocates of value-based insurance design (VBID) have argued based on break-even economic modeling that VBID can be effective but acknowledge that direct medical savings from increased use of services with strong evidence of clinical benefit are unlikely to finance the entire [VBID] investment in th...

Descripción completa

Detalles Bibliográficos
Autores principales: Fairman, Kathleen A., Curtiss, Frederic R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10438081/
https://www.ncbi.nlm.nih.gov/pubmed/21348548
http://dx.doi.org/10.18553/jmcp.2011.17.2.156
_version_ 1785092707487580160
author Fairman, Kathleen A.
Curtiss, Frederic R.
author_facet Fairman, Kathleen A.
Curtiss, Frederic R.
author_sort Fairman, Kathleen A.
collection PubMed
description Advocates of value-based insurance design (VBID) have argued based on break-even economic modeling that VBID can be effective but acknowledge that direct medical savings from increased use of services with strong evidence of clinical benefit are unlikely to finance the entire [VBID] investment in the short term. Thus, these VBID proponents support investments in processes to define low-value care and a benefit design that couples cost-sharing reductions for high-value services with cost-sharing increases for services not identified as high value. This suggestion has led to an important emerging issue for employers considering VBID adoption, provider and patient acceptance of higher levels of cost-sharing for services deemed low-value. Since publication of our earlier observations about deficiencies in research on VBID, new copayment reduction studies using nonrandomized comparison groups have been published, and an additional study measured the association between medication adherence and all-cause health care costs. Although all the VBID studies provided evidence that implementation of VBID might have a small favorable effect on medication adherence, none provided the information that payers need to make an informed decision about VBID because of serious problems in reporting, program design, and effect calculation. None of the new VBID studies reported its effect on generic drug utilization, and none reported the cost of the intervention to the payer. There are still no randomized controlled trials of VBID. Thus, nearly a decade after pharmacy benefit copayment reduction was initially proposed as a means to improve the outcomes of patients with chronic health conditions, health plan sponsors have little of the information that they need to assess the costs and benefits of VBID.A follow-up article on the subject of this editorial is available here:  VBID, the PPACA, and FREEE Medications: Did Politics Trump the Evidence About Cost Sharing? 
format Online
Article
Text
id pubmed-10438081
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher Academy of Managed Care Pharmacy
record_format MEDLINE/PubMed
spelling pubmed-104380812023-08-21 What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors Fairman, Kathleen A. Curtiss, Frederic R. J Manag Care Pharm Editorials Advocates of value-based insurance design (VBID) have argued based on break-even economic modeling that VBID can be effective but acknowledge that direct medical savings from increased use of services with strong evidence of clinical benefit are unlikely to finance the entire [VBID] investment in the short term. Thus, these VBID proponents support investments in processes to define low-value care and a benefit design that couples cost-sharing reductions for high-value services with cost-sharing increases for services not identified as high value. This suggestion has led to an important emerging issue for employers considering VBID adoption, provider and patient acceptance of higher levels of cost-sharing for services deemed low-value. Since publication of our earlier observations about deficiencies in research on VBID, new copayment reduction studies using nonrandomized comparison groups have been published, and an additional study measured the association between medication adherence and all-cause health care costs. Although all the VBID studies provided evidence that implementation of VBID might have a small favorable effect on medication adherence, none provided the information that payers need to make an informed decision about VBID because of serious problems in reporting, program design, and effect calculation. None of the new VBID studies reported its effect on generic drug utilization, and none reported the cost of the intervention to the payer. There are still no randomized controlled trials of VBID. Thus, nearly a decade after pharmacy benefit copayment reduction was initially proposed as a means to improve the outcomes of patients with chronic health conditions, health plan sponsors have little of the information that they need to assess the costs and benefits of VBID.A follow-up article on the subject of this editorial is available here:  VBID, the PPACA, and FREEE Medications: Did Politics Trump the Evidence About Cost Sharing?  Academy of Managed Care Pharmacy 2011-03 /pmc/articles/PMC10438081/ /pubmed/21348548 http://dx.doi.org/10.18553/jmcp.2011.17.2.156 Text en Copyright © 2011, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Editorials
Fairman, Kathleen A.
Curtiss, Frederic R.
What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title_full What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title_fullStr What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title_full_unstemmed What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title_short What Do We Really Know About VBID? Quality of the Evidence and Ethical Considerations for Health Plan Sponsors
title_sort what do we really know about vbid? quality of the evidence and ethical considerations for health plan sponsors
topic Editorials
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10438081/
https://www.ncbi.nlm.nih.gov/pubmed/21348548
http://dx.doi.org/10.18553/jmcp.2011.17.2.156
work_keys_str_mv AT fairmankathleena whatdowereallyknowaboutvbidqualityoftheevidenceandethicalconsiderationsforhealthplansponsors
AT curtissfredericr whatdowereallyknowaboutvbidqualityoftheevidenceandethicalconsiderationsforhealthplansponsors