The impact of a value-based insurance design plus health coaching on medication adherence and medical spending

The objective of this study was to evaluate medication adherence, medical services utilization, and combined medical and pharmacy expenditures associated with diabetes and hypertension value-based insurance design (VBID) plus health/disease coaching programs implemented by a large employer. A pre/post participant versus nonparticipant study design was used to measure medication possession ratios (MPRs), inpatient admissions, emergency room utilization, and combined medical and pharmacy expenditures for employees/spouses with diabetes (n = 1090; average 23 months follow-up) and hypertension (n = 3254; average 13 months follow-up) participating in a VBID plus health/disease coaching relative to eligible nonparticipants. Outcome measures were propensity score weighted and regression adjusted to estimate the independent impact of the programs. MPRs for diabetes and hypertension were significantly increased 3 to 4 percentage points for VBID participants, while MPRs for respective nonparticipants decreased by about 10 percentage points. Employer-paid pharmacy expenditures increased significantly for both participants with diabetes and hypertension while out-of-pocket patient co-payments decreased significantly. Medical expenditures for diabetes VBID participants decreased but not significantly. Hypertension participants experienced medical expenditure increases. Medical services utilization of inpatient admissions and emergency room visits underwent minimal change. Thus employer-sponsored diabetes and hypertension VBID plus health/disease coaching programs can be expected to lower patient co-payments and significantly increase medication adherence. Meanwhile, medical spending outcomes indicated that increased diabetes and hypertension pharmacy expenditures were partially offset by medical savings (for diabetes) but not sufficiently to be cost neutral.