By Sharon Begley
NEW YORK, Dec 19 (Reuters) – A new U.S. health insurance
model uses financial sticks and carrots to steer patients toward
the most beneficial care.
The model, known as value-based insurance design, makes
patients foot more of the bill for medical procedures of
questionable value, like surgery for enlarged prostate and many
back operations, and less – even zero – for unquestionably
beneficial care such as vaccines and hypertension treatment. But
while health policy researchers have been pushing the idea for a
decade, it is only now catching on.
Some examples:
*In the largest experiment with financial sticks, Oregon’s
state employees – about 275,000 workers and dependents – moved
in 2010 to a value-based healthcare plan.
“We said you’re going to pay more for back surgery, for
high-tech imaging, for hip replacement,” said Joan Kopowich,
administrator of the state Public Employees’ Benefit Board.
“People got it, and we’ve seen some pretty dramatic changes.”
With employees shouldering an extra $500 for less-effective
medical services, she said, MRIs have fallen almost 30 percent
and musculo-skeletal procedures such as spinal fusions are down
as much as 17 percent. “Spending is dropping like a rock,” she
said, benefiting employees: Premiums, which had been rising by
some 7 percent a year, are now falling 0.5 percent a year.
*In August, when Michigan became the 25th state to expand
Medicaid under President Barack Obama’s Affordable Care Act
(ACA), the legislation required value-based design.
By next July, Michigan Medicaid plans must have co-pays that
“encourage use of high-value services, like prescription drugs
for high blood pressure, and discourage use of lower-value
ones,” said Michigan Medicaid Director Stephen Fitton.
His agency has begun to identify the latter with the help of
academics and other health-policy experts.
*In South Carolina, the Medicaid program no longer pays for
elective inductions of labor or cesarean deliveries prior to 39
weeks of gestational age, which obstetricians advise against.
*Under an Obamacare plan in Maine that uses value-based
design, patients will have zero co-pays for many more services
than Obamacare requires, said Kevin Lewis, chief executive of
Maine Community Health Options. But they will pay more for
unnecessary MRIs and other procedures that, studies show, do not
improve outcomes.
“We’re making this investment because someone has to make
the first move toward improving health outcomes,” said Lewis.
“We’re committed to decreasing the total cost of care, and we
know the only way to do that is by engaging both providers and
patients.”
(Reporting by Sharon Begley; Editing by Michele Gershberg and
Douglas Royalty)
