Medication adherence improvements don't always curb costs

Value-based insurance design programs (VBID) may need to target specific populations and run for years before payers and patients reap significant gains from them, according to a new Health Affairs study.

The study examined a VBID program offered by Blue Cross and Blue Shield of North Carolina, which increased the insurer's medication expenditures by $6.4 million while saving a "nonsignificant" $5.7 million in other healthcare costs. Overall, the study's findings provided limited support for the idea that VBIDs can be cost-neutral for high-risk or older populations with cost barriers to medication adherence. But VBIDs can improve these customers' overall quality of care, the study found.

BCBSNC's program eliminated copayments for generic medications and lowered copays for brand-name drugs. Medication adherence improved 2.7 percent to 3.4 percent during the two-year study period. Inpatient admissions fell modestly, but no significant changes in emergency department use or overall health expenditures occurred.

Value-based insurance designs aim to align disease control with cost containment. The programs support population health improvement by driving patients to high-value doctors, products and services through reduced or eliminated cost sharing. Though use of VBID's is mandated by the Affordable Care Act, there's little evidence of their return on investment, the study noted. One purpose of the Health Affairs study was to begin filling that information gap.

The study included 176 large, mainly self-funded employers representing more than 638,000 enrollees. Researchers compared healthcare consumption and spending one year before and two years after the VBID implementation.

Researchers examined data on three groups: People diagnosed with hypertension, patients with hypertension and hyperlipidemia and patients with hypertension and coronary artery disease. The first group had the lowest cardiovascular risk while the last had the highest. Study participants were established oral medication takers, continuously enrolled in BCBSNC's health insurance plans from 2007 to 2009 and diagnosed before the VBID implementation. 

For more:
- see the Health Affairs study abstract

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