Both the House and Senate are incorporating value-based insurance design elements into their health insurance reform bills.
Though foreign to the American public, the concept has already been embraced by many employer groups.
The idea is to make “clinically sensitive, financially relevant” incentives in benefit designs meaningful to get people to change, said Cyndy Nayer, president of the Center for Health Value Innovation.
Journal Communications wanted to engage local employers in southeast Wisconsin in collective value-based purchasing. That didn’t happen, but the Milwaukee-based company began its own plan designed around diabetes in January 2007, said Jeff Kleuver, a risk manager.
The plan offers diabetic employees and dependents free medication and supplies in exchange for one-on-one coaching with a pharmacist. The meetings take place on company time at the workplace or a public location.
He said the program has been so successful – impacting its medical spend trend and recording reductions in A1C1 levels, blood pressure and cholesterol – that the company rolled out a cardiovascular health program in April, which offers co-pay deductions in exchange for one-on-one coaching.
Seattle-based Group Health Cooperative will roll out a new plan design in January 2010 that incorporates incentives and deterrence, said Cindy Johnson, vice president of human resources.
The plan marries health promotion activities and wellness programs in the workplace with plan benefits, said David Grossman, MD, medical director for preventive care.
The integrated health system, which employs 9,000 people, is focusing on six diseases and decreasing cost shares in pharmacy benefits and monitoring devices, as well as waiving co-pays for chronic disease visits.
“We believe we’ll see positive ROI in year three,” Johnson said.