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Value-Based Decision-Making
Resources for PPOs
For many PPOs the role of the PPO clinical leadership may be to bring best practice information to purchasers. There is increasing evidence that tailored benefit design can improve diabetes and other chronic care management by using incentives to reward high value services. For example, many payers are experimenting (or have results of effectiveness) with VBID approaches reward patients and providers for carrying out evidence based treatments and behaviors. The goal of VBID is to create incentives for patients and providers to adhere to programs to prevent illness or complications, and to avoid services that are not linked to better outcomes.
VBID strategies around diabetes could include::
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Offering benefit incentives to encourage patients to adopt healthy lifestyles
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Rewarding participation in a program of weight loss and exercise that reverses pre-diabetes
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Reducing co-pays for essential diabetes-related services and medications
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Covering adherence support services such as counseling by a pharmacist or diabetes educator
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Creating tiered benefits for services based on the value of the services
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Creating tiered networks of providers based on the quality and efficiency of providers
For More PPO Specific Ideas on VBID
Download the AAPPO VBID White Paper Here
Important Sources of Evidence on VBID include:
Health Affairs
They published a November, 2010 edition featuring evidence from economic studies and employer experiments with VBID. Articles specifically assess the evidence supporting use of VBID as a cost and quality strategy. The special edition also examines “low value” services, e.g. those that add little value to health encounters and could be targeted with disincentives for use.
Center for Value-Based Insurance Design
The Center for Value-Based Insurance Design is an academic center that evaluates health care financing approaches and promotes value-based insurance benefit designs. The VBID Landscape Digest includes important case studies and references to literature. The Center conducts research on value-based insurance design and offers links to research by its own faculty as well as related studies. The Center offers articles on cost sharing, lowering costs and improving benefits. Research focuses on new approaches to patient contribution and effectiveness in health care. Presentations from Center leadership are posted, as are dates for future events.
Center for Health Value Innovation
The Center for Health Value Innovation is made up of employers searching for value in purchasing decisions. The center has a number of publications and case studies examining how purchasers can use contracting decisions and clinical evidence to drive better outcomes and lower costs.
National Business Group on Health
The National Business Group on Health (NBGH) is a non-profit organization offering employers resources for understanding and managing health care concerns in the workplace. The National Business Group on Health provides employers with information on a wide variety of health and benefits topics as well as new developments in health care policy. The diabetes resource page offers materials to employers to increase diabetes awareness and prevention programs in the workplace. NBGH offers the "Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage", a comprehensive toolkit for employers on preventive health services, including a purchasers' guide, cost-calculators and presentations.
United Health Plan
United Health Plan launched a diabetes Health Plan specifically built around value based purchasing concepts. The plan promotes evidence based care by offering incentives and rewards to patients and provider who follow treatment guidelines.
In Fall 2008, AAPPO rolled out a series of special issue Webinars with the “Adding Value” theme. These events were designed to bring expert information to PPO senior leaders. For slides, speaker bios and audio recordings from selected Adding Value Webinars please click here.
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