Currently, more Americans comparison-shop for their auto mechanics than for their doctors. Yet, prices vary greatly within geographic areas and are not consistently linked to quality. This indicates that if consumers were empowered to choose high-value providers and services, they could receive better care and save money. Within the U.S., the increasing prevalence of high deductible health plans and health savings accounts along with continued upward price trends makes it imperative for consumers to spend their health care dollars wisely. Lack of price and quality transparency presents a major barrier to consumer engagement. Access to information is only a first step, though. Value-based insurance design, which aligns consumers’ incentives with value, can further improve health care outcomes and affordability.
Health Care Quality and Price Transparency
Individual consumers lack the information they need on the price and quality of medical services. With the following steps, we can begin to enhance transparency and provide all of us with better data to inform our health care choices:
- Support the efforts of plans, employers, and others to offer online tools that allow consumers to comparison-shop on both price and quality.
- Promote the movement toward parsimonious sets of core outcome measures, in Medicare and across payers. (while retaining flexibility to address the needs of certain specialties and covered populations)
- Ensure the broadest possible provider participation by minimizing the reporting burden, by incorporating advanced registry or EHR-based measures and by permitting small practices to join together in ‘virtual groups’ for purposes of quality measurement, reporting, and improvement.
Value-Based Insurance Design (VBID)
Consumers who seek out the highest value care should have a chance to realize financial savings. Value-based insurance design (VBID) bases cost-sharing on quality and value rather than price, reducing cost-sharing for health care services with demonstrated high value. VBID programs have achieved increased utilization of high-value services and prescriptions, produced better health outcomes for enrollees, and in some cases, generated cost savings. The following adjustments to current law and regulations would allow millions to benefit from value-based insurance:
- Enable Medicare Advantage plans, as well as Accountable Care Organizations, to reduce copays for high-value providers and services.
- Permit consumer-directed health plans in the private market to cover certain evidence-based, high-value services – such as podiatric foot exams and metformin for diabetics – prior to the exhaustion of the deductible.