Many employers and health plans are moving toward health benefit plan designs to support value-based purchasing, enhance consumer engagement, facilitate behavior change, and reward high quality, efficient health care.

Value-based benefit design focuses on improving quality of care and on managing health to avoid costly acute care and the costs associated with lost time and low productivity. Thoughtful health benefit design can result in a package that offers a provider network and cost-sharing rules that encourage use of higher performing, more efficient providers, and use of preventive services and evidence-based treatment of chronic disease, while discouraging unnecessary tests and wasteful procedures.

The explosion of strategies to engage consumers in their own health care and steer them toward higher-value options, includes:

• Steering employees toward providers with good cost and quality records.
• Requiring employees to complete a health risk appraisal so employers better understand workforce health needs.
• Offering disease management programs and incentives to use them for people with ongoing health conditions.
• Offering wellness/health promotion programs for everyone.
• Tying employee premium contributions to smoker status.
• Offering "tiered" co-payments (lower co-payments in exchange for choosing better performing providers or for selecting generic drugs).
• Creating incentives for use of high value treatments and services (such as beta-blockers).
• Targeting patients with certain diagnoses (such as diabetes or heart disease) and creating incentives for them to use high-value services for treatment and control of their disease.
• Offering "optional" benefits.

VBBD Resources

	Value-Based Insurance Design, Health Affairs, article by Michael E. Chernew, Allison B. Rosen, and A. Mark Fendrick
	Explains how to create a high-value health system by abandoning the principle that all services must cost the same for all patients.
	MBGH Annual Employer Benefit Survey Reveals Growing Shift to Value-Based Benefit Design
	Reports findings from 2008 survey regarding shift toward value-based benefit design.
	Value Based Benefit Design: a purchaser guide, published by the National Business Coalition on Health
	What Employers Should Know about Value-Based Benefit Design
	A Powerpoint presentation with 43 slides and speaker notes for use by DFWBGH for employer members as an educational tool. DFWBGH members may request a free copy by contacting DFWBGH.
	BeneFIT Design: Seven Steps to Value-Based Health Benefits Decisions, by Jack Mahoney, MD and David Hom, published by GlaxoSmithKline
	This practical resource on VBBD provides the skills and action steps necessary for employers to create an effective value-based health benefit program.
	WorkScripts™, a tool for employers to help them launch a value-based benefit design for pharmaceutical benefits, developed by GlaxoSmithKline
	The toolkit includes a Manager's Action Guide which provides a step-by-step approach for improving employees' adherence to prescription medications for treating high-cost chronic conditions, such as diabetes.
	Health Benefits Education for Small Employers
	Provides Department of Labor advice about how to avoid insurance scams that prey on small businesses.
	For technical assistance and employer tools related to health benefit design, see: Midwest Business Group on Health
	See "Health Benefit, Health Care & Insurance Information & Tools" near the bottom of the page.
	2008 Prescription Drug Benefit Cost and Plan Design Report, an online survey report produced by the Pharmacy Benefit Management Institute
	The report provides an overview of U.S. trends in prescription drug coverage, plan design, utilization, and drug costs.