A Web First article published January 21 by Health Affairs reports new evidence that value-based insurance design (VBID) programs, in which patients pay little or no copayment fees for high value health care services, can break even, or even save money.  The results, reported by Harvard’s Michael Chernew and coauthors, came from analysis of data from one large corporation that implemented a VBID program in 2005. Copayment rates were reduced for employees using five classes of drugs used to treat several serious but common chronic conditions, including diabetes and hypertension.

A 2008 Health Affairs article by Chernew and coauthors on VBID won the Research Award from the National Institute for Health Care Management Foundation.

The VBID program analyzed in the new article was implemented by Active-Health Management, an independent subsidy of Aetna. Patients using the specified medications were offered at least a 50% copayment reduction.  The authors examined employee spending on the subsidized high value services and overall spending by the employer using the VBID plan, and compared both to a control employer with similar benefits that did not lower copayments.  The percentage of eligible patients taking their medication increased from about 70 to 73 percent and, as a result, non-drug spending (e.g., hospitalizations) was reduced.  The results suggest that the program likely had a favorable financial profile when both employer and employee costs were considered and that a substantial portion of the added employer spending on high-value prescription drugs was offset by fewer hospitalizations and emergency department visits.