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Value-Based Insurance Design

Value-based insurance design

Aligned with the goals of value-based clinical care to improve outcomes and reduce costs through data analytics and quality, value-based insurance design (VBID) is a growing approach among private and public payers.

The basic objective of VBID is to reduce co-pays and/or premiums for high-value healthcare services that are clinically relevant to individual patients. The goal is reducing financial barriers to motivate patients to seek medications, preventive treatments and wellness visits, for example, they may otherwise forego within a more traditional “one-size fits all” out-of-pocket pricing structure.

The Philips Wellcentive platform

Aligned with population health management clinical care, one key to VBID success is the ability to identify patients needing access to – or who have been missing – clinically relevant healthcare needs, often tied to chronic conditions.

The Philips Wellcentive platform helps health systems and health plans (private insurance or employer-sponsored) to identify at-risk patients, then track and share progress throughout tailored interventions and provide reporting that bridges results to contracted health systems seeking improved outcomes.

CMS models underway

In 2017, The Centers for Medicare & Medicaid Services (CMS) launched multi-state demonstration models of value-based insurance design in seven states planned for a five-year period. The models match commercial insurer, university and employer health plans with Medicare Advantage patients and target diabetes, COPD, CHF and other chronic conditions.

Initial participating states include:

  • Arizona
  • Indiana
  • Iowa
  • Massachusetts
  • Oregon
  • Pennsylvania
  • Tennessee

The agency plans to expand the models to Alabama, Michigan and Texas in 2018 and target conditions such as arthritis and dementia into the clinical focus.

More information on VBID model designs, industry and Congressional approaches and studies of clinical and financial outcomes can be found at The Center for Value-based Insurance Design.

Case study

Philips Wellcentive helps MGM Resorts stack the wellness odds in employees’ favor

A detailed analysis of how Philips Wellcentive helped MGM Resorts International, a major employer, improve their health plan through data aggregation and organization solutions.

Read case study »

Tying interventions to outcomes is the goal of PHM platforms. We use Philips Wellcentive to coordinate data and achieve scale across the system and all patients. EMRs can make that connection, but only for individual patients.”

Paula Holmes, Senior Director of Accountable Care, Seattle Children’s

Tying interventions to outcomes is the goal of PHM platforms. We use Philips Wellcentive to coordinate data and achieve scale across the system and all patients. EMRs can make that connection, but only for individual patients.”

Paula Holmes, Senior Director of Accountable Care, Seattle Children’s

Proven impact

Scalable to network growth

Scalable to network growth

Clinical and financial analytics engine scales with health system and provider expansion

Custom readability formats

Custom readability formats

Storyboard results matching time-sensitive health organization goals

Unique data collection

Unique data collection

Ability to pull data internally and from industry benchmarks

Pertinent to All Models

Pertinent to All Models

Clinical and financial analytics gauges performance for all-payer incentive models

 

Disrupting care delivery for the better

Cindy Gaines, Vice President and Chief Operating Officer of Borgess Health, a member of Ascension Health, breaks down how population health has disrupted their care delivery model for the better—and how Philips Wellcentive’s PHM solutions are helping them meet their accountability measures and enhance their patient engagement strategies.

Let’s talk   

What are your biggest challenges in value-based care? Every day, we are helping providers transform the way they deliver care, supporting enhanced patient outcomes and improved use of data. Reach out to us today to learn how you can avoid the cost of inaction and power your success in the new healthcare landscape.

Contact us today to start your journey to value-based care success.