Value-based insurance design (VBID) creates financial incentives or removes financial disincentives to affect consumer choices and incentivize the provision of cost efficient health care services. Value-based insurance designs can also lower or eliminate copayments for high value services and medications or increase cost sharing for services considered to be of uncertain value. Value-based insurance plans often cover preventive care services, wellness visits, and treatments such as medications to control blood pressure or diabetes at low to no cost1.
Expected Beneficial Outcomes (Rated)
Increased medication adherence
Reduced patient costs
Other Potential Beneficial Outcomes
Reduced health care costs
Improved health outcomes
Evidence of Effectiveness
There is strong evidence that value-based insurance design (VBID) increases patients’ adherence to medication and reduces their out-of-pocket expenses2, 3, 4. Additional evidence is needed to confirm effects of VBID on clinical outcomes and health care utilization and spending3.
Value-based insurance plans that provide generous benefits, target high-risk patients, offer wellness programs, provide financial incentives only for medication ordered by mail, and do not offer disease management programs have a significantly greater impact on medication adherence (4-5 percentage points) than plans without these features5. VBIDs that target costs of low value as well as high value care are more likely to moderate cost growth and improve overall value than plans that only encourage the use of high value care; however, categorizing any health care services or medications as low value is politically challenging6. A Connecticut-based study indicates greater use of standard preventive measures such as colonoscopies, pap smears, and lipid tests for all plan enrollees and increased service utilization for individuals with chronic conditions such as diabetes, heart disease, and asthma following VBID implementation7.
By reducing copayments and improving medication adherence, VBID appears to reduce racial and ethnic disparities, and improve cardiovascular disease outcomes for minority patients8, 9. VBID is also a suggested strategy to reduce disparities in health care outcomes between individuals with lower and higher incomes9; however additional evidence is needed to confirm these effects3.
Overall, VBID appears to be cost neutral in the first three years after implementation, as increases in prescription drug spending balance reductions in non-drug medical spending3. VBID is a suggested strategy to reduce health care spending in the long-term, however, studies are needed to confirm effects over time1, 2.
Impact on Disparities
The Affordable Care Act (ACA) Section 2713 mandates coverage of certain preventive care services through group health plans and individual health insurance coverage, establishes guidelines for using value-based insurance design, and restricts the use of cost-sharing or copayments for specified high value services and medications10. As of 2014, 40% of commercial in-network payments were considered value-oriented11.
Many local governments and public entities have implemented aspects of VBID in their public employee health plans, for example, the state of Oregon, Colorado Springs School District 11, and Chippewa County, Wisconsin. Many large companies and corporations have also implemented VBIDs, such as CVS Caremark, Pitney Bowes, Caterpillar, and Marriott International1.
UM-CVBID - University of Michigan (UM), Center for Value-Based Insurance Design (CVBID). Publications.
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1 NCSL-VBID - National Conference of State Legislatures (NCSL). Value-based insurance design.
2 Lee 2013 - Lee JL, Maciejewski ML, Raju SS, Shrank WH, Choudhry NK. Value-based insurance design: Quality improvement but no cost savings. Health Affairs. 2013;32(7):1251-7.
3 Tang 2014 - Tang KL, Barnieh L, Mann B, et al. A systematic review of value-based insurance design in chronic diseases. The American Journal of Managed Care. 2014;20(6):e229-41.
4 Maciejewski 2014 - Maciejewski ML, Wansink D, Lindquist JH, Parker JC, Farley JF. Value-based insurance design program in North Carolina increased medication adherence but was not cost neutral. Health Affairs. 2014;33(2):300-308.
5 Choudhry 2014 - Choudhry NK, Fischer MA, Smith BF, et al. Five features of value-based insurance design plans were associated with higher rates of medication adherence. Health Affairs. 2014;33(3):493-501.
6 Neumann 2010 - Neumann PJ, Auerbach HR, Cohen JT, Greenberg D. Low-value services in value-based insurance design. The American Journal of Managed Care. 2010;16(4):280-286.
7 UM CVBID-CT brief 2015 - University of Michigan (UM), Center for Value-Based Insurance Design (CVBID). 2015 Connecticut's Health Enhancement Plan for state employees: Improving health outcomes and consumer engagement. 2015.
8 Choudhry 2014a - Choudhry NK, Bykov K, Shrank WH, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Affairs. 2014;33(5):863-870.
9 UM CVBID-VBID brief 2016 - University of Michigan (UM), Center for Value-Based Insurance Design (CVBID). V-BID in action: The role of cost-sharing in health disparities. 2016.
10 US CMS-ACA Implementation - Centers for Medicare & Medicaid Services (CMS), The Center for Consumer Information & Insurance Oversight. Affordable Care Act implementation FAQs - Set 12.
11 CPR-2014 Scorecard - Catalyst for Payment Reform (CPR). National scorecard on payment reform 2.0. 2014.
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