title: Connecticut's Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence.
abstract: In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services.
authors.affiliation: Richard A. Hirth (rhirth@umich.edu) is a professor in the Department of Health Management and Policy at the University of Michigan, in Ann Arbor.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hirth
authors.affiliation: Elizabeth Q. Cliff is a PhD candidate in the Department of Health Management and Policy at the University of Michigan.
authors.forename: Elizabeth Q
authors.initials: EQ
authors.lastname: Cliff
authors.affiliation: Teresa B. Gibson is a senior director of health outcomes research at Truven Health Analytics, in Ann Arbor.
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.affiliation: M. Richard McKellar is a research consultant for the Department of Health Management and Policy at the University of Michigan.
authors.forename: M Richard
authors.initials: MR
authors.lastname: McKellar
authors.affiliation: A. Mark Fendrick is a professor in the Departments of Internal Medicine and Health Management and Policy at the University of Michigan.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003237:Connecticut; D017046:Cost Savings; D017047:Cost Sharing / Q000191:economics; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000191:economics / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012189:Retrospective Studies; D000070376:Value-Based Health Insurance / Q000191:economics* / Q000706:statistics & numerical data; D062505:Value-Based Purchasing / Q000191:economics; D055815:Young Adult; D016903:Drug Monitoring
keywords: Chronic Care; Consumer Issues; Cost of Health Care; Evidence-Based Medicine; Insurance Coverage < Insurance