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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. Value-Based Insurance Design

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

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

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • State legislation, regulations, and policy documents and tracking data
  • VBID models pilot program data and evaluation
  • Healthcare utilization and cost data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of educational sessions and technical assistance encounters provided by Title V agencies to health insurers, employers, and policymakers on the benefits and implementation of VBID. (Measures the efforts to build awareness and capacity for VBID adoption)
  • Number of consumers enrolled in health insurance plans with VBID features, disaggregated by demographics, socioeconomic status, and geographic location. (Measures the reach and penetration of VBID plans among different populations)

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

  • Percent of health insurance plans in the state that meet established criteria for high-quality VBID design, such as comprehensive coverage of preventive services and tailored cost-sharing reductions. (Measures the quality and robustness of VBID implementation)
  • Percent of health insurance plans with VBID features that actively promote and educate consumers about the availability and value of covered preventive services. (Measures the level of consumer engagement and health literacy support provided by VBID plans)

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

  • Number of multi-stakeholder collaboratives and task forces established to drive VBID adoption and implementation across the state's health insurance landscape. (Measures the level of cross-sector collaboration and collective action to support VBID scale-up)
  • Number of policy briefs, research studies, and data analytics projects conducted to build the evidence base and business case for VBID in the state. (Measures the use of data-driven approaches to inform and support VBID implementation)
  • Number of consumers from communities that have historically low preventive care utilization who enroll in VBID plans and access covered services. (Measures the intervention's success in reaching communities in need)
  • Number of state policies and regulations enacted to support and incentivize VBID adoption across public and private health insurance programs. (Measures the intervention's influence on creating a supportive policy environment for VBID scale-up)

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

  • Percent of VBID plans that include tailored outreach, education, and enrollment strategies for populations with the greatest need in preventive care access and utilization. (Measures the design and implementation of VBID interventions)
  • Percent of VBID plans that incorporate consumer feedback and preferences in the design and continuous improvement of covered services and cost-sharing structures. (Measures the level of consumer engagement and patient-centeredness in VBID implementation)
  • Percent of healthcare spending shifted from treatment of preventable conditions to preventive care services among populations enrolled in VBID plans. (Measures the intervention's effectiveness in reorienting healthcare resources towards upstream prevention and early intervention)
  • Percent of consumers who report sustained engagement in preventive care and improved health-related quality of life as a result of VBID plan enrollment, based on longitudinal surveys and patient-reported outcome measures. (Measures the long-term impact and value of VBID from the consumer perspective)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 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.