Incenting Employees To Take Their Medicine
Value-based insurance design, or VBID, can help employees stay on their medications for chronic medical illnesses after they switch to high-deductible health plans and face high out-of-pocket costs for their prescription drugs.
So says a new study by researchers from Kaiser Permanente published in the journal Health Affairs.
The findings are important as other research has indicated that many people enrolled in HDHPs often forego care, including not getting prescriptions filled, because of their high out-of-pocket costs. When people skip care or fail to get drugs they need to manage their chronic conditions, they may become acutely ill and require more expensive care from hospitals or medical specialists.
That fear is growing as more people enroll in HDHPs. A recent survey of more than 250 employers conducted by the Healthcare Trends Institute found that 53.1 percent offered employees an HDHP option this year compared 39 percent in 2016.
VBID is considered one way to counteract the care disincentives created by HDHPs. A VBID health plan encourages enrollees to use high-value care by reducing out-of-pocket costs for that care. It encourages enrollees to avoid low-value care by increasing out-of-pocket costs for that care. Typical health plans apply deductibles and co-payments equally across all types of care.
In the new study, researchers compared the medication adherence rates of 2,482 employees who switched to an HDHP in 2014. Some 87 percent of the employees had one of four chronic medical conditions: high blood pressure, diabetes, heart disease or heart failure. Most had prescriptions for diabetes, high blood pressure and/or high cholesterol drugs. The researchers defined adherence as the percentage of days per year employees had an adequate supply of medications for their conditions.
Of the enrollees who switched to an HDHP, 1,024, or about 41 percent, switched to a plan that included a VBID incentive. They paid no deductible or co-pay for their medications. They were free. The others switched to a plan without a VBID incentive. They paid the applicable deductibles and co-pays for their medications out of pocket.
From 2013 to 2014, the percentage of days with an adequate supply of medication decreased from 76.1 percent to 73.8 percent for the employees without a VBID incentive. Adherence dropped as out-of-pocket obligations rose. But for employees with a VBID incentive, the percentage of days with an adequate supply of medication remained about the same—from 74.3 percent to 74.1 percent. Adherence held steady as out-of-pocket obligations were eliminated.
“VBID provisions are a potential tool to use in offsetting financial barriers from deductibles and can help maintain low-cost access to high-value health care services and treatments,” the researchers said.
To learn more about VBID and how it can help control employer health care costs, read “Pushing the Right Buttons” in Twin Cities Business.