"Smarter" Deductibles Could Increase Use of High-Value Services

According to a recent commentary in JAMA Internal Medicine, rising health care spending has created fiscal challenges that emphasize the need to better engage consumers in their health care decisions to avoid medication non-adherence.

A Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan, and Michael E Chernew, PhD, of the department of health care policy at Harvard Medical School reviewed concerns facing plans with high deductibles that cause consumers to forgo essential care—when those deductibles should instead reduce low-value care.

“Ideally deductibles would lead to a reduction in the use of only low-value care,” Dr Fendrick and Dr Chernew wrote in their commentary. “To accomplish this goal, consumers must be able to distinguish between high-value and low value clinical services, which is difficult. Thus, increased costs haring contributes to avoidance of both low- and high-value care.”

The solution presented by Dr Fendrick and Dr Chernew, is a high-value health plan that covers evidence-based chronic disease services before the deductible is met and directs high deductibles to low-value services. According to the the authors, a slight increase in premiums is needed for a plan like theirs to work—the authors expect that despite increasing premiums, the plan design would still be popular among consumers.

“Clinically nuanced—or smarter—deductibles might be a natural evolution of health plans, in that consumer cost sharing would be reduced for the clinical services that are encouraged under many alternative payment models,” they said. “As value based reimbursement promotes the delivery of evidence based, high-quality care, consumer-facing initiatives must encourage—not create barriers—to these high-value services.”

According to the authors, efforts are underway to develop cost-sharing strategies that can replace the traditionally known approaches—alternative designs encourage high-value care, while reducing wasteful spending.

“Allowing health plans the flexibility to voluntarily cover more services outside the deductible would enhance consumer choice,” Dr Fendrick said in a press release. “The next generation health plan should be affordable, cover essential health care, and better engage consumers in their health care decisions.”

—Julie Gould 

References:

Fendrick M, Chernew ME. Precision Benefit Design—Using “Smarter” Deductibles to Better Engage Consumers and Mitigate Cost-Related Nonadherence [published online January 9, 2017]. Jama Intern Med. doi:10.1001/jamainternmed.2016.8747.