According to 30 years of this social experiment, the jury is still out. But value-based plans may be emerging as a useful model to promote rational use of care that works, while increasing consumer satisfaction.
Consumer-driven health plans (CDHPs) are framed in this discussion as plans that link high-deductible health insurance plans with tax-favored accounts.
The forum presented two sides of the argument: one from a health plan’s perspective, and one from the HR Policy Association. The plan’s view was optimistic; the HR Association’s, not-so-much.
1. Protection from catastrophic illness
An emerging model of health plans that employee benefits consultants discussed are value-based health designs. The objectives of these plans, according to Towers Perrin, are to achieve “maximum value for both individuals and plan sponsors.” Each enrollee’s health behavior would be encouraged, through benefit design, to use health services most appropriate to their needs. Incentives link copayments to clinically demonstrated benefits.
This approach is currently used by some employers in the area of prescription drug benefits; for example, an employer may totally eliminate the copay for a specific class of drugs for diabetics to motivate those employees to stay on their therapeutic regimen.
Health Populi’s Hot Points: Some of the best and brightest lights from the health plan design scene convened at this EBRI forum. As bright as their lights are, there remain real questions about what’s working in health plans and how to motivate citizens to get engaged in their own health and health care. It is too early to judge whether value-based benefit design will be a panacea for both motivating positive health behaviors and lowering costs to payers (including consumers) over the longer run.