Principles for Consumer-Friendly Value-Based Insurance Design
Value-based insurance design aims to help consumers understand which services or providers offer the best care at the best prices, and it offers financial incentives to consumers to seek high-value care.
Value-based insurance has the potential to improve patients’ health and lower health care costs. But it must be driven by high-quality clinical evidence and consumer-friendly principles to ensure that patients can get the care they need.
Key principles of consumer-friendly, value-based insurance design include:
- Relies on high-quality clinical evidence and evidence-based measures of clinical effectiveness and provider performance
- Emphasizes reducing the cost of high-value services
- Offers a robust network of high-value providers across care specialties and across geographic regions
- Rewards providers for delivering evidence-based care
- Provides consumers with resources that explain how value-based design works and tools to help them engage in health care decision making
- Has an accessible exceptions and appeals process
- Does not require participation in wellness or disease management programs
- Evaluates the program regularly