I recently came across a Health Policy Solutions article about a pilot program underway in Colorado’s San Luis Valley to analyze the impact of “value-based insurance design.” So far, the results look promising. The study has been going on for a year now, and involves 725 people who are enrolled in the San Luis Valley HMO. The pilot program will continue for the rest of 2013 and the results will be published in the summer of 2014. But thus far, it appears that both patients and doctors like the program. The doctors involved say they’d like to involve all of their patients, rather than just the ones who are part of the pilot program (this is in contrast to the doctors’ initial fears that it would be too time-intensive to provide the required level of education and engagement with their patients). And the patients like the feeling of empowerment and knowledge that goes along with the value-based insurance design; they also seem to be more likely to opt for less-invasive, lower-cost treatments, and are more invested in their own health and taking care of themselves.
A related study published in Health Affairs finds that patients who are less engaged with their own healthcare have greater total healthcare costs, and vice versa.
Both of these studies point to greater patient involvement as a key to improving outcomes, improving patient and doctor satisfaction, and lowering healthcare spending – all around, a win-win.
As the Health Policy Solutions article notes, adding an extra element to the design of health insurance plans runs contrary to the goal of simplifying the insurance purchasing process. Colorado – along with everyone else – is right in the middle of setting up its health insurance marketplace; states and insurance carriers are working to figure out what plan designs will be sold in the marketplace and there’s already some concern that markeplaces might struggle to provide adequate service due to the large numbers of enrollees that they’re anticipating starting this fall. Adding another element of policy differentiation (in the form of some policies that offer value-based insurance design) would likely add to the time it takes for enrollees to compare policy options and settle on the one that is the best fit for their particular situation. This is a valid concern, but the evidence so far seems to indicate that value-based insurance design might eventually be a good addition to all – or at least most – health insurance policies.
Since the San Luis Valley pilot program is still going to be going on when the Colorado marketplace gets underway this fall, I would imagine that possible pilot program-related changes to mainstream Colorado health insurance policies won’t show up in the very near future. But over the next several years, I wouldn’t be surprised to see more value-based health insurance design and plans that actively engage the patient. HSA-qualified high deductible health insurance plans have long sought to involve the patient as a “consumer” of healthcare who shops around for the best deals and avoids “unnecessary” treatment. But being a healthcare “consumer” is easier said than done, especially when it’s essentially up to the patients to initiate their own engagement and seek out their own resources. The benefit of the program being studied with the San Luis Valley is that it provides education materials (including DVDs) to patients and actively engages the doctors and patients to work together to seek out the best evidence-based course of treatment. So rather than patients trying to shop around for doctors and Google their healthcare questions to figure out what course of action will be least expensive and most effective, the patients are working with their doctors as a team, and are also motivated by the financial incentives built into the health insurance coverage.
With HSA-qualified plans, there have long been concerns that policy-holders are more likely to avoid necessary as well as unnecessary treatments, in an effort to save money. This is because the plan structure usually doesn’t cover any costs except preventive care until the insured has met the deductible. With the sort of value-based plan design being tested in the San Luis Valley HMO program, care that has a high level of evidence-based backing might be covered with no cost-sharing, while other treatments require some financial contribution from the patient. So it’s not the same as an HSA-qualified plan’s structure that just relies on a high deductible to deter a patient from seeking excessive care. And instead of putting all of the burden on the patient, the value-based insurance design incorporates a team approach, with involvement from patients, doctors and health insurance carriers. All in all, it seems like an excellent idea.