MedicalResearch.com Interview with:
A. Mark Fendrick, M.D.
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy
Director, University of Michigan Center for Value-Based Insurance Design
Ann Arbor, Michigan 48109-2800
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As Americans are being asked to pay more for the medical care, in terms of copayments and deductibles, one in four Americans reports having difficulty paying for their prescription drugs. One potential solution is “value-based insurance design,” or V-BID. V-BID, is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services to the patient. They are designed with the tenet of “clinical nuance” in mind— in that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where, and by whom the service is provided.
According to a literature review published in the July 2018 issue of Health Affairs, The researchers found that value-based insurance design programs which reduced consumer cost-sharing for clinically indicated medications resulted in increased adherence at no change in total spending. In other words, decreasing consumer cost-sharing meant better medication adherence for the same total cost to the insurer.
MedicalResearch.com: What should readers take away from your report?
Response: This report shows that decreases in cost-sharing, and the associated increases in medication adherence, resulted in no change on total health care spending. Overall, this suggests that the incremental drug spending was counteracted by decreases in spending for other health services. This evidence illustrates improvement in adherence with value-based insurance design, which lowers consumer cost-sharing for high-value drug classes with no additional health care costs.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should focus on evaluating patient-centered outcomes and health system quality metrics in the context of value-based insurance design, as well as its effect on preventable hospitalizations and reduced emergency department visits. The V-BID Center hopes to see public policy efforts directed towards the use of such programs.
MedicalResearch.com: Is there anything else you would like to add?
Response: Moving forward, the value-based insurance Center will continue to promote the development, implementation, and evaluation of health benefit designs that improve quality and lower costs – the primary goals of healthcare reform.
Value-Based Insurance Design Improves Medication Adherence Without An Increase In Total Health Care Spending
Rajender Agarwal, Ashutosh Gupta, and A. Mark Fendrick
Health Affairs 2018 37:7, 1057-1064
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