Robust healthcare IT provides Value-Based premium Design

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Healthcare IT newsAccording to Mark Fendrick, co-director of the Center for Value-Based premium Design, and other industry experts representing health plans, government and service providers, Robust healthcare IT systems in Chicago are capable of classifying cures according to patients’ profile, which is important for payers to manage value-depended benefits.

Dr. Fendrick mentioned “Health information technology, I think, is really the enabler, and it goes beyond electronic medical records. But I really do believe that when these systems are in place – and there are some already – we will know how to find the people that have hypertension and we will know how to find the other people with co-morbidities and risk factors.”

At the basic level Value-based systems will seek out individuals in certain populations and having accurate actionable data to identify individuals at risk for diabetes or other conditions is the former step. However throughout the presentation, Fendrick and others explained that Value-based care decisions are more nuanced than this.

For instance, colonoscopy imaging for males 50 to 74 is such a “high-value” service that fendrick in favor of paying the insured member to have one performed depended on both the developed outcome for patients for early diagnoses versus the high costs of treating colon cancer. However, it is not any easy to design a plan to offer incentives for all members in order to have regular colonoscopies.He also reported “This has very low value for a man who is 29 and is actually a dangerous procedure for a man who is 75 so it is this kind of nuanced care that we need to provide for this to work.”

Lewis Sandy, MD, senior vice president, clinical advancement for the UnitedHealth Group mentioned “You really need to think very holistically and comprehensively about the value-based programs, It is not just that we need a few levers on the benefit package, but it is also tools and capabilities, it is the IT infrastructure, the idea of consumer engagement and personalization is also very important.”Gail Knopf, vice president of product innovation with TriZetto Group reported that a presentation on VBID a couple of years ago only proved to her that it would require an assist from technology to make it work. Some technology and software providers are aimed to aid support the added infrastructure needed to manage VBID. 

Gail Knopf also explained “I immediately recognized that VBID is something that would have some legs, but needed technology to help enable it because of its complexity, while we have extensive claims administration systems, the idea of going beyond the fairly straightforward pharmacy benefit of relieving a co-pay for a drug and moving into the complexity for specific medical claims and procedures and being able to deliver the nuanced benefits that Mark (Fendrick) speaks of, all of that was going to require a significant enhancement in technology.”Despite that technology can be the enabler; much of the work is still up to people and industry to convert how they think about medical benefits and how we pay for our care. Consequently ultimately VBID will need to obvious the human hurdle if it is to become commonplace.

Jennifer Boehm, principal, health management practice AONHewit noted that “We have to get employers and, dare I say, health plans, comfortable with the idea that there are lower value services, I think the only way VBID lives on and is sustainable is over time is if we move in that direction.”


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