Kimberly Westrich Reviews Effective Strategies for Building Value-Based Benefits


With high-deductible health plans used by more than half of the US workforce, there are several value-based benefit design strategies to promote the use of high-value, cost-effective services, said Kimberly Westrich, MA, vice president of health services research. at the National Pharmaceutical Council.

Westrich recently participated in a panel discussion at the 2021 National Alliance Annual Forum titled “Building Better Benefits: Rethinking Value-based Benefit Design”.


What strategies can be learned from your research to build effective value-based benefits?

In fact, we have done a lot of research on high deductible health plans in recent years. And one of the reasons for that is that more than half of the workforce is enrolled in a high deductible health plan, and if you look at high deductible health plans from a value perspective. , it is actually a very brutal tool.

What does it mean? A blunt tool means that if you are a patient with a high deductible what we see happening is not only that you avoid this unnecessary care, which is low value care, but patients tend to avoid it as well. high-value care, prevention services that do not even have co-payment.

So a more nuanced tool would push us to adhere to these high value services and move away from these low value services. The high deductible health plan on its own is a blunt tool that doesn’t get that nuanced boost. So how could we get that nuanced nudge?

We can do this in several ways. One area in which we have done recent research is in the area of ​​predreducible chronic drug coverage. the [Internal Revenue Service] released new guidelines in 2019 that expanded the number of services that can be covered free of charge, and that include chronic medications that can prevent the exacerbation of chronic conditions like heart disease and diabetes.

The good thing is that it pushes us towards high value care. This lowers the financial barriers that could prevent patients from filling those important prescriptions, helps improve adherence, and ultimately keeps patients healthier, keeps them more productive at work, keeps them out of the hospital, and from the emergency room. So, in short, it spurs high value care.

Now we were really curious to see how these guidelines might have affected the value-based benefit design choices that employers were making. So we teamed up with Paul Fronstin, MD, of the Employee Benefit Research Institute, and A. Mark Fendrick, MD, of the Center for Value-Based Insurance Design, to assess the extent to which employers are actually adopting predictable drug coverage. chronic.

We found that three-quarters of employers had extended their pre-deductible coverage in response to this change in guidelines. So it’s encouraging to see changes in the design of value-based benefits that are designed to push us toward higher value care. And for people who want to learn more about prededucible coverage and why it makes sense, which is specifically allowed, we have a few resources on our website.

One is the briefing book that we wrote with Paul and Mark. The second is an action note on which we have partnered with the National Alliance of Healthcare Buyers Coalitions and this action note is called “Better Value, Smarter Franchises”.

Now, this predreducible chronic drug coverage is just one way a high-deductible health plan can be designed in a more value-based way. Other good practices in designing value-based benefits for high-deductible health plans include training your employees to know how to use the deductible, so that they know what services are covered. outside the franchise; by giving them tools so that they know in advance how much my medicine will cost? How much will this operation cost?

We have research that will likely come out in January 2022 that will delve into some of these best practices, and I look forward to sharing it with you in the near future.


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