Kimberly Westrich on Micro-, Macro-Level Approaches to Improve Value-Based Benefit Design

Although progress has been made to shift further away from fee-for-service to a value-based approach, there remain several opportunities to further incentivize and promote the use of high-value services, said Kimberly Westrich, MA, vice president of health services research at the National Pharmaceutical Council (NPC).

Westrich recently participated in a panel discussion at the National Alliance 2021 Annual Forum titled “Building Better Benefits: Rethinking Value-based Benefit Design.”

Transcript

What are some future opportunities for growth regarding value-based benefits?

I think I'll give you a micro-level answer and a macro-level answer. The micro-level answer focuses on some of the things I just talked about—predeductible coverage. That [Internal Revenue Service] guidance that came out in 2019 that expanded the types of services and medicines that could be covered predeductible was a great first step. And it's been fantastic to see so many employers picking it up.

But the reality is there are a lot more high-value services and medicines that could be covered in predeductible phase, which would nudge us even more in the direction of that high-value care that we'd like to see. And there's currently a multistakeholder effort underway to expand even further the services and medicines that could be covered predeductible.

The other part of my micro answer has to do with the extent that we're following good practices for value-based benefit design. In some cases, what we're seeing is value-based benefit design is what we're implementing. So with that predeductible coverage, we saw that three-quarters of the employers did adopt it—that's great.

But on the other side, we're not seeing a lot of tools out there that allow consumers to see ahead of time how much their medicines and their medical services are going to cost. So, that's an area for growth where we can do a better job of getting the tools out there so that employers and employees can be following the value-based benefit design.

On the macro-level, I think there are a lot of opportunities to incentivize value as we're continuing to get everyone away from fee-for-service and into the value-based world. We can do research to figure out what works, what doesn't work. I think pilots and demonstrations are a great way to test what interventions are actually working in the real world as far as getting patients to adopt that high-value care and stay away from the low-value care.

Then I think we can work together to continue to develop standardized, meaningful sets of quality measures so that we're all agreeing on what constitutes high-value care or low value care, and how we can meaningfully assess and measure it. If you put all of those things together, I think we can make even more progress in the coming years toward moving toward that value-based world that we would all love to be in.

I would encourage people who want to learn more about value-based benefit design to go to NPC’s website. We have a webpage called Building Better Benefits that has all of our research on the topic, and we also have a dedicated landing page for employer resources.