Is “Value-Based ” Value Wasted? Examining Value-Based Insurance Designs Through the Lens of Cost-Effectiveness

Health plan sponsors have long sought approaches to care management that not only reduce health care costs but also improve the health of plan members. Nearly a decade ago, disease management programs were first promoted as a possible solution. However, most of the recent evidence from controlled studies suggests that chronic disease management is not delivering on the promise of lowered costs through improved population health.1-3 Today, both in federal budget discussions and for commercial insurers, value-based insurance designs (VBID) are receiving increased attention, particularly for pharmaceuticals. At one time called benefit-based copayments (BBC), the original VBID model called for a shifting of the health plan subsidy away from low-value utilization and towards high-value utilization. “The BBC allows the copay to vary by the evidence-based benefit of the medication for the individual patient … For any given drug, patients with a high potential benefit would have lowe