Designing Insurance Benefits to Yield Better Outcomes

Patricia Salber

Posted 12/12/11 on The Doctor Weighs In

Co-pays and co-insurance were introduced into insurance benefit designs to help curb over-utilization that occurs because something is completely free (the “moral hazard” of insurance). The problem is that these cost-sharing vehicles may also reduce the use of beneficial services, such as prescription drugs.

The concept of Value Based Insurance Design (VBID) is the idea that benefits would be designed in a way that promotes the use of services that bring value to the individual(s) consuming them. A commonly used example is eliminating co-payments for diabetes drug used by beneficiaries with diabetes.

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Five Inevitable Trends That Will Change Physician Practices

BRIAN KLEPPER

Over at iPractice, a Sanofi-Aventis site aimed at helping physicians manage their practices, I detail several rapidly emerging trends – clinical/financial performance transparency, clinical decision support, a medical management revival, value-based benefit design and medical homes – as well as how physicians might respond.

The core thesis here is that these trends are inevitable, brought on by a system that lags far behind most industry sectors, with costs so wildly out of control that a large and rapidly growing percentage of individual and corporate purchasers have been priced out of the coverage market.

Head over and take a look. The goal is to help physicians face these trends head on so they can prepare to succeed as they take root and come to dominate the marketplace. Feel free to pose questions, and I’ll do my best to respond quickly.