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ASPPH News

Push For Clinically Nuanced, Value-Based Insurance Design (V-BID) Programs

In a recent New York Times article, Harvard economist Dr. Sendhil Mullainathan articulates strong support for clinically nuanced, value-based insurance design (V-BID) programs. Dr. Mullainathan highlights the well-documented problem of cost-related medication non-adherence and recommends that high-value drugs such as those that treat heart disease and diabetes be provided at no cost to the populations that need them. The concept of 'clinical nuance' was developed at the University of Michigan Center for Value-Based Insurance Design which was established at the University of Michigan School of Public Health. The basic tenets of clinical nuance are that medical services and providers differ in the benefit provided and that the clinical benefit of the service depends on the person using it as well as where and by whom the service is provided. Unlike “one-size-fits-all” plan designs that set a single co-payment for all clinician visits, diagnostic tests, and drugs, V-BID programs base cost-sharing on the clinical value of the service – not the cost. Published evidence concludes that clinically nuanced cost-sharing can improve care quality and lower health care expenditures while fostering consumer engagement. V-BID programs targeting evidence-based preventive care, clinician visits, diagnostic tests, drugs, and procedures have been implemented by hundreds of private and public organizations nationally.