Patient Engagement
Clip
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.

More From Patient Engagement
Organizational Mindset Is the Biggest Barrier to Engaging Patients as Consumers

Survey Snapshot: The Patient-Physician Relationship Is Key

Both parties involved in a consumer-facing transaction have access to important information about the product or service — but this isn’t the case with health care.

What High-Need, High-Cost Patients Say About How to Reduce High Utilization of ED and Inpatient Services

High-Need, High-Cost Patients Offer Solutions for Improving Their Care and Reducing Costs

More home health care and after-hours clinics, telemedicine, and home delivery of medications are among top solutions.

Top Physician Pain Points Identified by Chronic Patients

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence

With natural language processing and machine learning, researchers are identifying patient emotional and medical needs that are not being met by clinicians and patient advocacy groups.

Health Care Can Learn a Lot from Other Consumer-Facing Industries - Especially About Customer Service - Consumerization of Health Care

Patient Engagement Survey: Health Care Has a Lot to Learn from Consumer-Friendly Industries

The consumerization of health care continues to reshape the way that patients engage with providers and experience care. Most providers see this fundamental change in the health care model as a necessary response to changing patient demands, and have embraced the need to learn from other industries.

Bilazarian01_pullquote patient engagement both sides of the bed

Patient Engagement from Both Sides of the Bed

When patients and families are included in medical rounds as valued members of the team, the quality of care improves.

Ten Guiding Principles for Patient-Centered Care as Described by Mountain States Health Alliance to consider with patient-centered outcomes research (PCOR)

Complementary Approaches to Patient Engagement in Patient-Centered Outcomes Research

It’s important for providers to understand and apply the key principles foundational to patient-centered outcomes research efforts.

Selected Advantages of Improved Patient Electronic Access to Health Data

Patient-Led Data Sharing — A New Paradigm for Electronic Health Data

The pieces are in place for a truly disruptive shift in how patients can access and use their own clinical data to improve their health.

Collapse of Two Online Health Communities as Result of Removal of Users Starting from Superusers

Online “Superusers” as Allies of the Health Care Workforce

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health outcomes for people with chronic conditions.

The PEACE Project - Patient Experience for Acute Care Elders at Sarasota Memorial Hospital

The PEACE Project

Improving the acute care experience for our eldest patients.

Rabson01_pullquote barriers to patient engagement in primary care practices

What Does It Take to Increase Patient Engagement in Primary Care Settings?

Massachusetts primary care practices are beginning to invest in programs to increase patient engagement, but these strategies can be challenging to implement and remain underutilized and undervalued.

Connect

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

Learn More »

Topics

Patient Incentives

68 Articles

Online “Superusers” as Allies of the…

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health…

A Collaborative Model to Expand Medicaid…

How managing the benefit coverage expansion for the treatment of HCV in New Mexico was…

Healthy Nevada Project: Genetic Data Changing…

How 35,000 people spat in a tube so that their genetic information would be combined…

Insights Council

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

Apply Now