Because of all the changes happening in the health insurance industry due to the Affordable Care Act, many employers have been seeking different options for their company healthcare and their benefits programs that are available to their employees. We’ve discussed extensively how becoming self-insured is one of the most attractive options available to employers, but what about value-based insurance programs? Value based insurance can help yield better results for employers and be more effective for employees.
Benefit Programs that Recognize Value
Most employers who tell you that the truth is not all healthcare services are created equal. Some services are more effective than others. Value based plans aim to encourage employees to use the services that are more effective and beneficial. Employees are usually encouraged by a financial incentive to choose these services, like a lower copay. Research should be made to determine which healthcare services the highest possible benefit for the patient. Services that offer the highest values are those that offer outpatient treatment services like those that are offered at clinics.
Examples of Value-Based Insurance Designs
- Smoking Cessation Programs – it’s simple, of the best things that a smoker can do for their health is to quit smoking. It is in the best interest of employers to keep their employees as healthy as possible, so they might offer a smoker reimbursement for nicotine patches, gum, lozenges, nasal spray, inhalers, Bupropion, or Varenicline. There is also the option for addictions counseling, either in a group or individually.
- Selecting and Highlighting Quality Facilities – employers can offer cash incentives to employees that use the services of facilities that they consider to be ones of high quality.
- Improving Medication Adherence Rates – employers can consider eliminating the copay on prescription drugs if an employee shows adherence to taking them on time.
ACA Requirements for Value-Based Insurance
We mentioned earlier how the Affordable Care Act has changed a lot of things when it comes to workplace healthcare. Believe it or not, there are actually some value based insurance designs that are required by law. One of such requirements is that all health plans must offer preventive care services without the need for the employee to pay their copay. Some of these screenings include those for blood pressure tests, tests for colon cancer, and tests for sexually transmitted diseases.
Just because the ACA requires value based insurance designs doesn’t mean they are anything new. Well before the ACA’s passing, employers were implementing value based insurance programs like some of the ones mentioned above. One of the most common of these programs was employers to cover the costs of preventive screenings and procedures.
Value-Based Insurance Programs Gaining Popularity
Value based insurance programs are gaining in popularity, thanks to both the increased value for employees and potential savings for employers. One example is IBM, who saw a significant increase in employee screenings for preventive services and more employees were getting vaccinated. Chippewa County, Wisconisn waived out-of-pocket expenses for their county employees. They ended up saving about $700 per person and about $1.7 million total.
If you have any questions about value-based insurance and how it would impact your stop-loss insurance, don’t hesitate to contact one of our knowledgeable stop loss professionals.