Patient Engagement
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Can—and Should—Benefit Design Be Standardized? (05:10)

We need to push for simpler, more thoughtfully crafted value-based benefit designs, says NEJM Catalyst Lead Advisor Thomas Lee. But should those designs also be standardized?

“Having designs that people can actually understand, that don’t get in the way of them making good decisions, is a great idea,” says Katherine Baicker. “But I would love to see insurance plan innovation in having different designs that are actually well geared to the population they’re trying to serve.” She describes, for example, an insurance plan geared toward diabetics.

There’s also a role for nuanced financial incentives, Baicker says. But, she cautions, they have to be “encased within a plan that is for human beings and that promotes good health behaviors.” For example, if a plan that charges higher copayments for emergency department use — to discourage people from using EDs for non-emergency situations — is complicated, that’s neither good for patient care nor cost effective, because emergencies can’t be predicted ahead of time. But if the plan is designed to make visiting a primary care doctor less expensive than going to the ED, and the doctor has convenient hours, that can be beneficial.

Niteesh Choudhry agrees. “There’s a distinction between simple, of which I’m a huge fan, and still clinically appropriate or clinically nuanced,” he says. Value-based insurance design is about offering “the right services to the right patient at the right time,” and it is structured to place more value on clinical outcomes than on cost.

Choudhry also notes that insurance design and social incentives are only partial solutions. “They’re the way that insurers can do things or the way that employers can do things,” he says, “but they’re not exclusive.”

“I think we’ve been asking over the past couple of years for our insurance benefit design to do far more of the heavy lifting than it really is capable of doing,” adds David Asch. “There are so many other elements of our health care system that can carry some of the weight there and really will have to.”

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

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