Evaluation of value-based insurance design for primary care

Area of Science:

• Health Economics
• Health Services Research
• Insurance Design

Background:

• Value-based insurance design (VBID) aims to improve healthcare access and outcomes by reducing patient cost-sharing for specific services.
• Understanding the impact of VBID on overall healthcare spending is crucial for evaluating its effectiveness and sustainability.

Purpose of the Study:

• To evaluate the impact of removing patient cost-sharing for primary care visits on overall healthcare spending.
• To assess changes in healthcare service utilization associated with VBID implementation.

Main Methods:

• A quasi-experimental, difference-in-differences (DID) design was employed using administrative claims data.
• The study compared healthcare spending and utilization between a VBID cohort and a propensity score-matched comparison cohort before and after benefit changes.
• The analysis included commercially insured enrollees younger than 65 years with continuous eligibility from 2008 to 2014.

Main Results:

• The VBID cohort experienced a statistically significant $12.0 per member per month relative reduction in overall healthcare spending compared to the comparison cohort (P = .02).
• This reduction was primarily driven by decreased expenditures for emergency department (ED) visits and other outpatient services, with corresponding declines in utilization.
• No significant relative increase in spending was observed for physician office visits in the VBID cohort.

Conclusions:

• Implementing VBID by reducing cost-sharing for primary care did not lead to increased overall healthcare spending.
• The findings suggest that VBID can be a strategy to manage healthcare costs while potentially improving access to primary care.