How does value-based health care design work?

22040027 - close up image of human hand holding electrical bulb in darknessCurious about value-based health plan design? If you’re looking for a better way to keep your employees healthy and manage your health insurance costs, it’s definitely worth learning more.

Value-based design is different from the design of traditional health plans. With many traditional plans, for example, consumers pay the same deductible and/or copayment for a variety of health services.

With value-based plan design, however, this cost-sharing between the consumer and the insurance company varies. What employees pay out-of-pocket in copayments or deductibles, for example, is often reduced or even eliminated for ‘high-value’ care.

That’s care by high-quality providers that research shows is likely to have the best health outcome(s) for a particular patient AND prevent future (and more expensive) health problems. An example would be a health plan that has no out-of-pocket costs for physician visits and medication designed to control chronic health conditions such as high blood pressure, high cholesterol, diabetes and other conditions that if not properly managed can become very costly to treat.

Likewise, value-based plan design increases cost-sharing for care considered low-value or care provided by low-quality providers. One key part of value-based plan design is to steer away from costly treatments and services that have been shown to be no more effective than less expensive options.

These two themes of value-based health plan design work together to steer consumers toward the successful management of their health conditions. It’s also designed to promote the most efficient care — not the most expensive. Questions about value-based plan design? We’re here to help you.