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Issue Brief
December 2013

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