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

January 9, 2017, University of Michigan Health System

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 ."

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 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 .

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 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 care, and better engage consumers in their decisions."

Explore further: One size should not fit all when it comes to our out-of-pocket health care costs, experts say

More information: JAMA Internal Medicine, DOI: 10.1001/jamainternmed.2016.8747

For more about the High-Value Health Plan concept, visit vbidcenter.org/wp-content/uplo … HP-Summary-Final.pdf and vbidcenter.org/initiatives/hsa … ctible-health-plans/

Related Stories

One size should not fit all when it comes to our out-of-pocket health care costs, experts say

September 30, 2016
If you've tried to see a doctor, fill a prescription or get a diagnostic test lately, you've probably had to pay more out of your own pocket than you would have even a few years ago. Most insurance plans have increased their ...

What do health plan deductibles really mean for people with chronic illness?

January 9, 2017
For tens of millions of Americans, the start of a new year means the counter has gone back to zero on their health insurance deductible. If they need health care, they'll pay for some of it out of their own pockets before ...

AAP cautions against high-deductible health plans for kids

April 28, 2014
(HealthDay)—High-deductible health plans (HDHPs) are an increasingly popular way to reduce health care expenditures, but may be particularly inappropriate for children, according to an American Association of Pediatrics ...

Are high-deductible health plans enrollees better health care price shoppers?

January 19, 2016
Enrollees in high-deductible health plans were no more likely than enrollees in traditional plans to consider going to another health care professional or to compare out-of-pocket cost differences across health care professionals ...

Fallout from increase in high-deductible plans examined

October 3, 2013
(HealthDay)—The expected increase in high-deductible health plan (HDHP) enrollment due to implementation of the Affordable Care Act (ACA) highlights the need for more research into the health impact of HDHPs, according ...

Recommended for you

Accurate measurements of sodium intake confirm relationship with mortality

June 21, 2018
Eating foods high in salt is known to contribute to high blood pressure, but does that linear relationship extend to increased risk of cardiovascular disease and death? Recent cohort studies have contested that relationship, ...

Fans of yoga therapy have yet to win over doctors

June 21, 2018
Yoga practitioners often tout the unique health benefits of the ancient discipline—from relieving stress and pain to improving vascular health—but most doctors remain sceptical in the absence of hard proof.

Fruit and vegetables linked to changes in skin colour, new research finds

June 21, 2018
Skin colour in young Caucasian men is strongly linked to high levels of fruit and vegetable consumption, new research by Curtin University has found.

What a pain: The iPad neck plagues women more

June 20, 2018
Is your iPad being a literal pain in the neck?

Medicaid work requirements and health savings accounts may impact people's coverage

June 20, 2018
Current experimental approaches in Medicaid programs—including requirements to pay premiums, contribute to health savings accounts, or to work—may lead to unintended consequences for patient coverage and access, such ...

Introduction of alcohol found to adversely impact fertility rates in hunter-gatherer community

June 19, 2018
Fernando Ramirez Rozzi, a research director with the French National Centre for Scientific Research has found that the introduction of alcohol to a Baka pygmy hunter-gatherer society caused fertility rates to fall. In his ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.