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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 1: Well-Woman Visit

MCHbest Logo well-woman visit

Strategy. Value-Based Insurance Design

Approach. Support the shift to value-based insurance design for all health insurance models within the state.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. Value-based insurance design (VBID) creates financial incentives or removes financial disincentives to affect consumer choices and incentivize the provision of cost efficient health care services. Value-based insurance plans often cover preventive care services.

Evidence. Scientifically Supported. There is strong evidence that value-based insurance design (VBID) increases patients’ adherence to medication and reduces their out-of-pocket expenses.* Additional evidence is needed to confirm effects of VBID on clinical outcomes and health care utilization and spending. Value-based insurance plans that provide generous benefits, target high-risk patients, offer wellness programs, provide financial incentives only for medication ordered by mail, and do not offer disease management programs have a significantly greater impact on medication adherence (4-5 percentage points) than plans without these features. VBIDs that target costs of low value as well as high value care are more likely to moderate cost growth and improve overall value than plans that only encourage the use of high value care; however, categorizing any health care services or medications as low value is politically challenging. By reducing copayments and improving medication adherence, VBID appears to reduce racial and ethnic disparities, and improve cardiovascular disease outcomes for minority patients. VBID is also a suggested strategy to reduce disparities in health care outcomes between individuals with lower and higher incomes; however additional evidence is needed to confirm these effects. Overall, VBID appears to be cost neutral in the first three years after implementation, as increases in prescription drug spending balance reductions in non-drug medical spending. VBID is a suggested strategy to reduce health care spending in the long-term, however, studies are needed to confirm effects over time.

Read more in theĀ WWFH database report. Read more about WWFH's evidence ratings. (*Links to studies can be accessed through the WWFH database).

Target Audience. State/Sytems.

Outcome. Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

Examples from the Field. Access descriptions of current ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the shift to value-based insurance design for all health insurance models within the state.,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of health insurance plans following value-based insurance design.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of health insurance plans following value-based insurance design.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women insured by value-based insurance who report accessing a preventive medical visit in the past year.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women insured by value-based insurance who report accessing a preventive medical visit in the past year.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.