Value-based design could boost quality: study

Value-based insurance design—the strategy of lowering copayments for services relative to their costs—could improve the quality of healthcare, according to a study published in the November issue of the journal Health Affairs.

Stating that there has been little empirical evidence to support the use of value-based design, the authors studied the U.S. company Pitney Bowes, which eliminated copayments more than three years ago for cholesterol-lowering statins and reduced them for clopidogrel, a blood-clot inhibitor. Researchers found the move was associated with a 2.8% increase in adherence to statins relative to controls, which was maintained for a subsequent year.

“In 2006 adherence declined by similar rates in both cohorts, but the implementation of the new policy on Jan. 1, 2007, was associated with a stabilizing of adherence in the intervention cohorts, which declined among controls,” the authors wrote.

The analysis followed another article in this month's issue that said high copayments for medical services cause patients to underuse essential therapies.

At a briefing about the articles, Karen Ignagni, president and CEO of America's Health Insurance Plans, referred to the articles as “very, very thoughtful papers” and talked about the importance of aligning incentives with medication adherence. Ignagni also said more information is needed about comparative-effectiveness research with regard to drugs and procedures; that cost should be a consideration; and that groups should work collaboratively in this effort.