Speaker: Mark Fendrick, Director, Value-Based Insurance Design (V-BID) Center, University of Michigan (www.vbidcenter.org)
Writer: Christiane Zhao
The increasing medical expenditures do not only reflect the increasing pressure in accessing to care but also question the fee-for-services payment method in the United States. Such a payment method is measured based on the provider types, and it is not directly correlated with the clinical outcome. As each service is paid separately, it emphasises the quantity rather than the quality of care. A growing body of evidence concludes that increases in consumer costs lead to a reduction in the use of essential services, worsens health disparities, and in some cases, leads to higher overall costs.” Mark referred this statement from an article in The New York Times. In the setting of ‘patient-centeredness’, US consumers are paying a higher percentage of their health care.
Mark pointed out that there is an underutilisation of high-value care persists across the entire spectrum of clinical care, and Value-Based insurance design is the main contributor to deal with the medical cost growth in this country. The adoption of such a model has created a rapid movement to targeted screening, diagnostics and therapies.
Hundreds of public and private payers have successfully implemented Value-Based insurance design. It is essential to be well-aware that clinical services differ in the benefit produced, and the clinical benefits depend on who receives it. The high-risk groups can bring higher value in return of the services compared with the low-risk group. Through the setting of cost-sharing to encourage higher utilisation of high-value services and providers and discourage the use of low-value care. For instance, the application of USPSTF Recommendation(A set of criteria) for BRCA-related cancer services.
“Clinician and patient incentives for precision medicine should aim to get the right service, to the right patient, at the right time, by the right clinician, at the right price.” Mark states, “Collaborations within and between the government, industry and academia is the key predictor to achieve such goals. ” Based on this, reduce the financial and non-financial barriers is another essential step to enhance the access of evidence-based services in a targeted fashion. Care providers should also consider ways that can increase population access to care, including introducing telehealth and add supplement benefits to the disadvantaged groups.
Declaimer: This article is generated based on a talk given at the 9th US-CHina Health Summit in Boston, the United States in 26th September 2019. The views and opinions expressed in this article only reflect the speaker’s opinion and does not necessarily reflect the author’s official policy or position. All rights reserved.