title: Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression.
abstract: BACKGROUND
  Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression.
  
  
  OBJECTIVE
  To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes.
  
  
  METHODS
  A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days).
  
  
  RESULTS
  The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in the pre-VBBD period; P = .004), the initiation of new medications for anxiety or depression (31.4% vs 29.5%, respectively; P = .033), and the filling of generic medications for anxiety or depression (85.1% vs 80.5%, respectively; P <.001). A multivariable adjusted analysis revealed a 0.05 increase in MPR after the benefit enhancement (P = .002). Healthcare utilization, costs, and absenteeism were not statistically different before and after the VBBD policy change.
  
  
  CONCLUSIONS
  The VBBD strategy was associated with improved medication adherence and cost-conscious medication use. Future analyses should explore whether these trends persist over time, and if they can further impact healthcare utilization, cost, and absenteeism.
authors.affiliation: Biostatistician, Cerner Population Health Services, Kansas City, MO.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.affiliation: Scientist, Cerner Research Services, Culver City, CA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Aguilar
authors.affiliation: Director of Business Intelligence and Analytics, KaMMCO Health Solutions, Topeka, KS, and Senior Financial Analyst II, Children's Mercy Hospital, Topeka, KS.
authors.forename: Eric
authors.initials: E
authors.lastname: Thompson
authors.affiliation: Medical Director, Population Health Services, Cerner Health Connections, Culver City, CA.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Miller
keywords: anxiety; depression; medication adherence; medication possession ratio; value-based benefit design