Evaluation of Value-Based Insurance Design With a Large Retail Employer

Objectives: To measure adherence and assess medical utilization among employees enrolled in a disease management (DM) program offering copayment waivers (value-based insurance design [VBID]). Study Design: Retrospective matched case-control study. Methods: Cases were defined as those enrolled in DM, of whom 800 received health education mailings (HEMs) and 476 received telephonic nurse counseling (NC). Controls were eligible for the DM program but did not enroll. Cases and controls were matched 1:1 based on propensity score (n = 2552). Adherence, defined by proportion of days covered, was calculated for 4 diseases using incurred drug claims 1 year before and after the DM program was implemented. Unadjusted and adjusted linear regression compared changes in adherence. Costs and utilization were compared at 1 year and 1.5 years after versus 1 year before implementation. Results: Members receiving NC had improved adherence for antihypertensives, diabetes medications, and statins (beta = 0.050, P = .025; beta = 0.108, P < .001; beta = 0.058, P = .017). Members receiving HEMs had improved adherence only for diabetes medications (beta = 0.052, P = .019). Total healthcare costs for NC members increased by $44 +/- $467 versus $1861 +/- $401 per member per year (PMPY) for controls (P = .003) at 1.5 years post-implementation. Total healthcare costs for HEM members significantly increased ($1261 +/- $199 vs $182 +/- $181 PMPY for controls; P < .001) at 1.5 years. Conclusion: VBID may be effective in improving medication adherence and reducing total healthcare costs when active counseling is provided to high utilizers of care. (Am J Manag Care. 2011;17(10):682-690)