G3 - Value_Based_Benefit_Design

G3 - Value_Based_Benefit_Design - Value-Based Benefit...

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Value-Based Benefit Design By: Iris Chen, Christopher Mapes, Albertino Tran, Ozioma Uche, Caroline Wesemuller "Way of designing pharmaceutical benefits so that drug co-pays are based on clinical value rather than underlying drug costs."
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Definition of Value-based Benefit Design Explicit use of incentives to encourage enrollee to adopt: Appropriate use of high value services Healthy lifestyles Evidence-based treatment Enrollee incentives include: Rewards Reduced premium shares Adjustments to deductibles and co-pays “Recognizing that the value of services varies by individual, VBBD advocates that enrollee cost sharing be based on the value (benefit net of cost) of the service/lifestyle program/provider to the individual enrollee, and should not be the same for all enrollees or be based simply upon the price of the service.” Value = benefit / cost
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Formation of VBBD 1. Specify target conditions based on the prevalence of conditions within the population enrolled i.e asthma o Establish baseline for adherence rates to track improvement of compliance o Assess adherence scores to determine where adherence is low o Target adherence score = 80 Asthma score generally low Diabetes, HTN, and hyperlipidemia generally high 2. Create a structured plan Consider a 3-tier system Qualification for discount is unnecessary to obtain medication o i.e. No need to meet target goals or participate in management program to qualify
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Why is this an Issue Overall? Pros
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This note was uploaded on 09/14/2011 for the course PHARM 1 taught by Professor Staff during the Spring '11 term at UCSD.

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G3 - Value_Based_Benefit_Design - Value-Based Benefit...

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