Researchers have found that a value-based insurance design test increased medication adherence, but it failed to be cost neutral, suggesting that the business case for VBID may be more convincing over several years or with higher risk patients.
Blue Cross Blue Shield of North Carolina eliminated copayments for generic medications and reduced copays for branded medications over a two-year program to evaluate whether a population group with chronic conditions would be more motivated to adhere to them. The analysis of the program, which was available to 750,000 enrollees, was published in February's Health Affairs.
The reason for investing in VBID is based on linking copayments to clinical value and that higher medication and administrative expenses will be offset by lower non-medication expenses resulting from better disease control. Studies to date had each tracked the experience of a single self-insured employer.
"However, our study found only partial support for the view that eliminating medication copays can be cost-neutral," the report authors said.
Patient adherence improved 2.7 percent to 3.4 percent during the study. Hospital admissions decreased modestly, but there were no significant changes in emergency department use or total health spending.
The insurer spent $6.4 million in higher medication costs, but total non-medication spending decreased $5.7 million.
Reductions in copays for medications similar to the one examined in this population-based program are likely to increase since the Affordable Care Act allows federal health officials to establish guidelines for insurers to use VBID.
To bend the cost curve, "ambitious, population-based interventions" will be needed, the report said. Small, incremental adjustments have not changed the trajectory of health expenditures.
The researchers found slightly reduced spending per person among the smaller group of high-risk patients with hypertension and coronary artery disease (CAD), but greater aggregate decreased spending among the larger group of lower-risk patients with hypertension alone.
Further studies should stratify patients by risk and disease prevalence to identify the groups that produce the greatest return on the insurer's investment, the report said.
Since health spending did not decline overall in the two-year program, "there is an urgent need to establish the conditions under which it would be cost-neutral," the report authors said. "The business case for value-based insurance design may be more compelling over the long term or for high-risk subgroups," such as older patients or those for whom cost is a critical barrier to adhering to their medications.