Patient Engagement
Talk
Value-Based Insurance Design: Theory vs. Practice (04:23)

Compelling literature backs up the idea of basing co-payments on the clinical value of a service. However, broader adoption of this strategy is complicated by several barriers, according to Niteesh Choudhry, Executive Director of the Center for Healthcare Delivery Sciences at Brigham and Women’s Hospital.

The first is figuring out which services to apply this concept to and the basic details of their design. Value-based insurance design has thus far been almost exclusively applied to drugs, but there are a number of other services to consider for cost sharing, such as non-drug therapeutics.

“Perhaps the greatest benefit or potential benefit of this idea of basing co-payments on value would be achieved by raising co-payments for those things that are of low value,” says Choudhry. “If we’re really going to drive economic value, that’s where it would come [from].”

“Equally important when it comes to applying value-based insurance design in practice is that we need to really be thoughtful about how we do it,” adds Choudhry. “So if you’ve seen one value-based insurance program you’ve seen exactly one value-based insurance program.”

Second, because most health care in the U.S. is employer sponsored, insurance is often fragmented: employees change employers frequently, and employers change insurers frequently. Employers and insurers may therefore be reluctant to adopt value-based insurance strategies. “We need to think thoughtfully about how to create incentives for employers to actually do this in the short run,” says Choudhry.

Lastly, Choudhry says, we need to do a better job of targeting who we use this strategy for. Much of the improvement in adherence resulting from these strategies has come from patients who had already been adherent. “There are small improvements in adherence for the population as a whole and many patients who did not actually respond at all,” notes Choudhry. “So as we move forward for this quality improvement intervention or any of the wide varieties in benefit design or broader into technology, we need to do a much better job of making this trade-off.”

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016. Watch Part 1 of Niteesh Choudhry’s talk: An Alternative Approach to Insurance Design.

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