Nav: Home

New year, new idea: High-value health plan concept aims for bipartisan appeal

January 09, 2017

As Washington grapples with the fate of the Affordable Care Act, a pair of health care researchers has proposed a new way to design health insurance plans that could win bipartisan support - and has already started to do so.

In an invited commentary in JAMA Internal Medicine, the University of Michigan's Mark Fendrick, M.D., and Harvard University's Michael Chernew, Ph.D., put forth the framework for what they call a "high-value health plan."

It's the first peer-reviewed publication to put forth the idea, which has also appeared in a bipartisan U.S. House bill introduced in the last Congress.

The idea combines the consumer-driven, market-based concepts of high deductible health plans linked to health savings accounts, with exemptions that enhance coverage for the clinical services that have been proven to benefit patients the most.

Currently, all HDHPs must cover certain preventive services without asking patients to pay for them out of their deductible. But existing regulations do not allow these plans to cover services to manage chronic disease.

As a result, patients with chronic illnesses such as diabetes, depression, or heart disease must pay the entire cost of their tests, appointments, and prescriptions until they meet their plan's deductible. Many of these services are proven to keep their condition from getting worse, and in some cases have been found to lower total health care spending.

About 40 percent of privately insured Americans under age 65 have HDHPs, including many people who have bought insurance on the Healthcare.gov marketplace. Each year, these plans require an individual to pay at least $1,300 -- and a family the first $2,600 -- of their health costs before their benefit coverage kicks in. In many plans, deductibles are substantially higher than this - a frequently raised issue in health reform discussions.

Republican-supported health policy proposals aim to increase the use of HSAs, which give people a tax-free place to put cash aside to pay for their deductibles and other health expenses. But HSAs, which are available to anyone with a HDHP, have been criticized by Democrats as being mostly useful to people with higher incomes.

For two decades, Fendrick and Chernew have studied how out-of-pocket costs can cause lower-income people and those with chronic illness to skip needed care.

The new JAMA Internal Medicine includes two research articles about the impact of HDHPs on personal health care spending.

The High Value Health Plan concept that the pair proposes would require a change to the federal tax code, to give health insurance companies more flexibility in designing HDHPs.

"Allowing health plans the flexibility to voluntarily cover more services outside the deductible would enhance consumer choice," says Fendrick, a professor in the U-M Medical School and School of Public Health who heads the Center for Value-Based Insurance Design (V-BID).

While the monthly premiums for HVHPs would need to be modestly higher than those for existing HDHPs, the HVHP premiums would be lower than for most traditional plans. He says, "The next generation health plan should be affordable, cover essential health care, and better engage consumers in their health care decisions."
-end-
For more about the High-Value Health Plan concept, visit http://vbidcenter.org/wp-content/uploads/2016/12/HSA-HDHP-Summary-Final.pdf and http://vbidcenter.org/initiatives/hsa-high-deductible-health-plans/

University of Michigan Health System

Related Affordable Care Act Articles:

Affordable Care Act slashed the uninsured rate among people with diabetes
The Affordable Care Act (ACA) provided health insurance for an estimated 1.9 million people with diabetes, according to a newly published study.
Many still uninsured after Affordable Care Act Implementation
In community health centers in Medicaid expansion states, among established patients who were uninsured prior to the Affordable Care Act, many remained uninsured after implementation of the Obama-era law.
Nonphysician practitioners absorbing more new patient requests post Affordable Care Act
The advent of the Affordable Care Act has led to millions of new patients seeking primary care.
Fewer people died from heart disease in states that expanded Medicaid coverage through the Affordable Care Act
Counties in states that expanded Medicaid coverage under the Affordable Care Act had fewer deaths annually from heart disease compared to areas that did not expand Medicaid, according to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019.
Affordable Care Act delivers significant benefits for women
According to a new study appearing in the American Journal of Preventive Medicine, published by Elsevier, the rate of health insurance coverage and access to affordable acute and preventive care services improved for women after the implementation of the Affordable Care Act (ACA).
More Affordable Care Act News and Affordable Care Act Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...