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Impact of Value-Based Insurance Design on Medication Utilization and Costs in a Large Retail Employer

May/June 2011, Vol 4, No 3 - Conference Highlights AMCP

Value-based insurance design (VBID) has been a driving force in lowering patients’ cost-sharing for evidence- based interventions that improve clinical outcomes. Yoona A. Kim, PharmD, and colleagues from the University of California San Francisco, the University of Texas at Austin, and Mercer Health & Benefits in San Francisco measured the impact of implementing a VBID program in a large retail employer on medication utilization and cost among employees taking medications for diabetes, asthma, coronary artery disease, or heart failure.

Patients were eligible for reduced cost-sharing if they had any of these diagnoses and agreed to enroll in a disease management program. Patients in the disease management program received either nurse counseling or health education materials, depending on their risk stratification, with those at higher disease risk receiving active nurse counseling and those at lower risk receiving educational materials.

Regression analysis showed that among those receiving passive education materials, medication adherence improved significantly only among patients with dia betes; in those receiving active counseling by a nurse, improvement was seen in patients taking antidiabetes medications, antihypertensives, or statins.

After 1.5 years, those in the nurse counseling group had significantly lower total overall cost ($44 ± $467) compared with those in the matched control group ($1861 ± $401) per member per year (PMPY). Those in the health education materials group had an overall total cost of $1261 PMPY compared with $182 PMPY in the control group.

The results, the team suggest, show that VBID can improve adherence, at least with some interventions and some types of patients. Active counseling appears to be a better strategy than providing passive educational materials for increasing appropriate healthcare utilization, improving clinical outcomes, and reducing total healthcare costs.

The team noted that the risk stratification and different intervention modalities may be a limitation of this study; they suggest that future studies should not separate the assessment of active counseling and passive education to assess the true impact of each intervention.

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Last modified: August 30, 2021