Medicare may test 'value-based' coverage design

Typically, when an employer or health plan wants to lower their healthcare costs, they raise co-pays and deductibles, usually without much of an eye to what impact that has on vulnerable patients' health.

Some, however, have tried out an alternative known as value-based insurance design, under which the plan lowers or eliminates co-pays for drugs for the chronically ill, such as meds for diabetes, asthma and heart disease. The notion, which has proven out for employers like Marriott and Pitney Bowes, is that by removing barriers to basic care, patients with such conditions will take their drugs and see their doctors.

Now, a pair of U.S. Senators have filed legislation that would create a demonstration project bringing VBID to Medicare. Supporters of the bill note that 23 percent of Medicare beneficiaries have five or more chronic conditions, and by themselves account for almost 70 percent of Medicare spending.

Right now, however, some of these chronically ill patients don't get the treatments they need due to cost considerations. Statistics show that the Medicare Part D population takes five prescription drugs per day on average, and almost 20 percent aren't able to fill a prescription--or delay filling--because of the cost, according to a recent white paper by Avalere Health and the Center for Value-Based Insurance Design.

To learn more about the VBID bill:
- read this Health Leaders Media piece

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