One of the provisions of the Affordable Care Act calls for the creation of guidelines to facilitate the broader use of Value-Based Insurance Design (VBID) plans. Existing VBID plans have been structured in a variety of ways, and these variations could influence their effectiveness. A new study, “Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence,” released today as a Web First by Health Affairs, evaluated seventy-six VBID plans introduced by a large pharmacy benefit manager (CVS Caremark) during 2007-2010.
Authors Niteesh Choudhry, Michael Fischer, Benjamin Smith, Gregory Brill, Charmaine Girdish, Olga Matlin, Troyen Brennan, Jerry Avorn, and William Shrank found that after adjusting for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for the medication ordered by mail had a significantly greater impact on adherence than plans without these features.
The study sample consisted of 274,554 patients provided by thirty-three unique plan sponsors. The majority of VBID plans did not have generous benefits, used copay tiers, and had a disease management program for the condition that the plan targeted. The authors noted that the positive association between wellness programs, patient targeting, and mail-order prescriptions was significant, considering that all these interventions are very low cost and easily implemented.
“Our study provides high-quality empirical data on the VBID plan features that appear to be most effective in stimulating greater medication adherence,” concluded the authors. “These results can influence how future copay reduction plans are structured. The method employed in our analysis could be used to evaluate other benefit design and quality improvement activities that also have large variations in their design features.”
Choudhry, Fischer, Brill, and Avorn are affiliated with Brigham and Women’s Hospital in Boston; Girdish, Matlin, Brennan, and Shrank are with CVS Caremark in Woonsocket, Rhode Island; and Smith is with Bozeman Deaconess Hospital in Bozeman, Montana. The study, which was funded by the Robert Wood Johnson Foundation, will also appear in the March issue of Health Affairs.