Patient Engagement 2016
Talk
An Alternative Approach to Insurance Design (04:45)

“When done right, insurance design is perhaps one of the most impactful tools we have to engage patients in their care,” says Niteesh Choudhry, founding Executive Director of the Center for Healthcare Delivery Sciences at Brigham and Women’s Hospital. Out-of-pocket costs are intended to make us think before we consume, says Choudhry, and therefore reduce our use of low-value services. This is effective, but there is an unintended consequence: being unable to determine which service is more important reduces the use of valuable services.

An alternative approach? Value-based insurance design. Through this model, cost sharing is low for services of high clinical value and high for services of low clinical value, explicitly creating incentives for patients to use valuable services. To show how well this can work, Choudhry describes a study conducted by his group in which heart-attack patients were randomized to receive evidence-based medications for free, or through their usual insurance coverage. Changing this benefit design — and nothing else — improved medication adherence and reduced clinical events and patient out-of-pocket spending.

“Perhaps one of the more important findings of this study was its impact on racial and ethnic disparities,” says Choudhry. His group divided study results based on whether patients reported their race or ethnicity as white or nonwhite. They found that the intervention had little impact for those who self-reported as white, but it had a major impact on those of nonwhite race or ethnicity, “so much so that the very large disparities in cardiovascular outcomes almost went away by doing something as simple as making evidence-based medications free.”

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016. Watch Part 2 of Niteesh Choudhry’s talk: Value-Based Insurance Design: Theory vs. Practice.

More From Patient Engagement 2016

Patient Inducements — High Graft or High Value?

Can health care be more like Uber and Lyft?

Consumer Engagement: New Tools and Capabilities for Health System Marketing

Novant Health is using research and data analytics to identify and engage new consumers, develop more relevant products and services, and support its mission and brand promise.

Shared Decision-Making for Good Clinical Care: Better, but Not Easier

Active patient involvement and patient autonomy can be burdensome to patients, especially when they are faced with serious illness. The primary goal of shared decision-making is not autonomy, but good care that fits patients’ lives.

The Patient as Consumer and the Measurement of Bedside Manner

Many physicians do not believe patient satisfaction is a legitimate pursuit. Yet they must meet consumers of health care where they are — on Internet ratings sites.

Halpern02_clip_still: A/B Testing Health Behavior Interventions

A/B Testing Health Behavior

Health care can’t implement changes overnight like Silicon Valley, but we can still learn from their version of treatment and control.

Social Interventions Can Lower Costs and Improve Outcomes

We can better serve our under-resourced patients by helping them access treatments and social interventions we already know to be effective.

Transparency and Trust — Online Patient Reviews of Physicians

Transparency of validated data about delivery-system performance has the power to change the culture of health care.

Patient-Researchers and Physician-Consultants Confront Chronic Disease

Personal-use sensors and data applications allow patients with Type 1 diabetes and other chronic diseases to take charge of managing their health. This is the future of chronic disease management.

Geisinger’s Refund Promise: Where Things Stand After One Year

Geisinger’s radical refund promise at one year — no evidence of financial catastrophe but a good return on patient trust.

My Favorite Slide: One Size Does Not Fit All in Behavioral Interventions

Behavioral interventions can have very different effects in different portions of the population.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Reading List: Victor Montori

Mayo Clinic Professor of Medicine Victor Montori shares key papers that have shaped his thinking…

Patient Incentives

50 Articles

Why Real-World Results Are So Challenging…

User engagement outside of clinical trials is the critical factor.

Diversity in Health Care Leadership —…

There’s a clear underrepresentation in the leadership in our medical schools and our hospitals —…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now