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As one approach to help mitigate the growing diabetes medical costs, one of Prime's large, fully-insured health plans initiated a VBID for diabetes drugs within their commercial book of business.
VBID began with the Asheville Project in 1997 when the city of Asheville, NC, waived member copays on diabetic drugs and supplies for city employees with diabetes in exchange for attending educational and counseling sessions delivered by pharmacists.
In the most basic approach to VBID, the employer simply lowers or eliminates co-payments for drugs or treatments that are proven to have high value relative to other treatment regimens.
High out-of-pocket costs are often cited as a culprit, and VBID might make a difference by linking patient co-payments to value.
The fundamental premise of VBID is that, for different people, different services have different values.
The pressures created by skyrocketing health care costs make VBID very timely.
CMS expects to release a Request for Applications for the second year of the model test in the fall of 2016, and will accept proposals from MA and MA-PD plans to offer VBID benefits in 2018.
Accordingly, a number of employers have adopted VBID programs, lowering copayments for services deemed to be high value (Chernew et al.
mortality post- statins and 2007 MI beta-blockers Maciejewski, Medication VBID (lower Health adherence to copays) Affairs.
In contrast, VBID plans reduce the cost to the patient for medications that offer higher clinical benefit, with the intent that increased medication use improves health outcomes and reduces overall health care spending.
VBID program managers try to set up co-payments, coinsurance rates, deductibles and plan networks in ways that encourage people to get high-value care they clearly need, such as blood pressure checks and efforts to keep diabetes under control, while reducing their incentive to get unnecessary care, potentially harmful care, or care of marginal value, such as antibiotics for colds, or questionable back surgery.
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