A Better Way to Cover High-Value Services

Rising healthcare expenditures, leading to increased consumer cost sharing, is a top concern in healthcare that crosses party lines. In a new commentary in JAMA Internal Medicine, A. Mark Fendrick, MD, and Michael E. Chernew, PhD, co-editors-in-chief of The American Journal of Managed Care, highlight the need for a “smarter” deductible.

There is concern that plans with high deductibles will cause consumers to forgo essential care when those deductibles should, ideally, reduce the use of low-value care. Unfortunately, deductibles discourage use of high- and low-value services.

The solution presented by Fendrick, director of the Center for Value-Based Insurance Design (V-BID) at the University of Michigan, and Chernew, director of the Healthcare Markets and Regulation Lab at Harvard Medical School, is a “high-value health plan,” which would cover evidence-based chronic disease services before the deducible is met and direct high deductibles to low-value services (such as those identified by the Choosing Wisely initiative). In order for such a plan to work, there would need to be a slight increase in premiums, but such coverage would likely be popular with consumers.

“Clinically nuanced—or smarter—deductibles might be a natural evolution of health plans, in that consumer cost sharing would be reduced for the clinical services that are encouraged under many alternative payment models,” Fendrick and Chernew wrote. “As value-based reimbursement promotes the delivery of evidence-based, high-quality care, consumer-facing initiatives must encourage—not create barriers to—these high-value services.”

They pointed to the introduction of H.R. 5652, also known as the “Access to Better Care Act of 2016,” which provides high-deductible health plans partnered with a health savings account the ability to cover chronic disease services before the deductible is met.

“Allowing health plans the flexibility to voluntarily cover more services outside the deductible would enhance consumer choice,” Fendrick said in a statement. “The next-generation health plan should be affordable, cover essential healthcare, and better engage consumers in their healthcare decisions,” Fendrick said.