Updated 'prevention' definition would better address quality, cost containment

May 19, 2014

Applying a value-based design to high-deductible plans would encourage chronically ill patients not to forgo necessary services

A value-based insurance design (V-BID) might be a better option for meeting the needs of chronically ill patients or those at risk for them. According to a new white paper from the University of Michigan Center for Value-Based Insurance Design and Harvard University Medical School, millions of Americans could benefit from expanded coverage of preventive services under health savings account (HSA)-qualified high-deductible plans that incorporate V-BID.

Individuals living with a chronic disease like diabetes, who are enrolled in a high-deductible health plan, must pay out-of-pocket costs for medically-necessary treatment such as blood pressure and cholesterol checks, eye and foot exams, and glucose monitoring services until the deductible is reached and insurance coverage begins. The report suggests that the Internal Revenue Service should expand its definition of preventive services so that employers and health plans can structure incentives under high-deductible plans, which in turn would encourage patients not to forego necessary services.

The change in the definition, according to the report, would allow patients with chronic conditions to access more covered care, the same way that insurers cover primary preventive care services under the Affordable Care Act. This translates to no charges, copayments or deductibles.

Aligning out-of-pocket costs with the value of healthcare services recognizes that different health services have different levels of value. By lowering or removing barriers to high-value treatments, via lower out-of-pocket costs, and discouraging low-value treatments (through higher costs to patients), these plans can achieve improved health outcomes at any level of healthcare expenditure.

"Our goal was to find ways to enhance the ability of high-deductible health plans to improve clinical outcomes of the chronically ill while reducing costs,” says A. Mark Fendrick, M.D., director of the University of Michigan Center for Value-Based Insurance Design, and one of the researchers who contributed to the paper. “We were pleased to discover that expanding the definition of ‘prevention’ to include evidence-based services that slow chronic disease progression and prevent related complications could potentially benefit millions of Americans.”