Value-Based Insurance Design: Perspectives, Extending the Evidence, and Implications for the Future

pany’s value-based design initiative.1 Pitney Bowes became the first company in the United States to fully implement this approach, in which the employer sets the amount of cost-sharing for a medical service or treatment according to the value of the intervention rather than its cost. Concurrently, Fendrick and colleagues introduced the value-based insurance concept in the peer-reviewed research literature.2 In the ensuing years, value-based design has been adopted by many employers, health plans, and payers.3 With healthcare reform, it is expected that more employers will implement value-based insurance design (VBID), and those with existing value-based designs may consider new approaches that extend beyond their current interventions. On the surface, the value-based approach is straightforward; however, controversy has emerged as value-based programs highlight a need within our healthcare system to define high-value and low-value services and “make ... decisions about not paying for things that don’t produce health.”4 Uncertainty has also emerged regarding the investment required by payers when lowering cost-sharing and whether the advantages resulting from increased adherence or improved outcomes are large enough to counterbalance the increase in benefit provision. Value-Based Insurance Design: Perspectives, Extending the Evidence, and Implications for the Future