What’s the role of consumers and patients in discussions about creating value-based insurance?
There are several ways to deconstruct that question, according to Niteesh Choudhry, the Founding Executive Director of the Center for Healthcare Delivery Sciences at Brigham & Women’s Hospital. The first is, “what do we mean by value? Is my value the same as your value?” The easiest conceptualization of value-based insurance design is clinical value. It’s supposed to be objective, notes Choudhry, but patients may value different clinical outcomes. In this context, “the idea that consumers have a voice in setting value-based insurance design is almost certainly true.”
Consumers may also have a voice in saying they don’t want insurance at all, and with high-deductible health plans, they can pay out of pocket until insurance kicks in. But this can have adverse consequences for patients. “So we’re left with this frame that we want to give patients choices — to [help them] make choices that are good for them — that are congruent with their values,” says Choudhry, “but also with the observation that those choices sometimes lead to health care outcomes that are not entirely congruent with their likely values or with societal goals as a whole.”
“The complexity of plans is crushing now,” adds NEJM Catalyst Founding Advisor Thomas Lee. “For everyone who practices, January was just a terrible month, with patients coming in completely confused.” According to Lee, the non-standardization of benefits and design threatens the Affordable Care Act. “I do think that consumers and patients should be complaining about the complexity, and on the health plan side, benefits people should be standardizing, and they should be trying to create the Apple version of health plans.”
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.