title: Encouraging value-based insurance designs in state health insurance exchanges.
abstract: OBJECTIVE
  One of the main goals of the Affordable Care Act (ACA) is to control the costs of US healthcare. Channeling patients toward more effective services is one of many approaches being used to control costs while improving health outcomes. This paper reviews value-based insurance design (VBID) concepts and discusses options for states to encourage these designs in the new health insurance exchanges (HIEs).
  
  
  METHODS
  We reviewed the literature on VBID as well as the text of the ACA for descriptions of how VBID might be encouraged through the new state health insurance exchanges.
  
  
  RESULTS
  States, under healthcare reform, are allowed to promote the use of VBID designs in their exchanges. There are 4 broad approaches a state HIE could pursue with regard to VBID, ranging from establishing a process for recommending high- or low-value services and requiring plans to adhere to the recommendations, to offering no guidance to plans. The evidence surrounding how well VBID designs work is growing, but it is still limited. To date there is no evidence that reducing or eliminating copays for preventive services cuts costs in the long term. However, modeling does suggest the potential for such long-term savings,so states should proceed with caution.
  
  
  CONCLUSIONS
  Modifying copays, even in small amounts, can send signals to patients about the relative value of drugs and services. However, long-term savings will likely result from higher copays on low-value services. The leadership of each exchange has a unique opportunity to reshape the insurance benefit landscape in its state to improve value and invest in prevention.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 305 W Monument St, #203, Baltimore, MD 21201, USA. cbuttorf@jhsph.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Buttorff
authors.forename: Sean R
authors.initials: SR
authors.lastname: Tunis
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
mesh_terms: D017047:Cost Sharing; D062265:Health Insurance Exchanges; D009042:Motivation; D058991:Patient Protection and Affordable Care Act; D013219:State Government; D014481:United States; D062505:Value-Based Purchasing / Q000458:organization & administration