Constituents of the U.S. healthcare system ready to adopt value-based insurance designs: Study

The TriZetto Group, Inc.Jul 1 2010

A new study commissioned by The TriZetto Group, Inc. finds that doctors, health insurers, consumers and other constituents of the U.S. healthcare system say they are ready and willing to adopt value-based insurance designs and related payment programs. Such designs encourage patients and clinicians to make better choices to improve care based on proven best practices, using both better information and financial incentives.

“They concur that a systematic, collaborative approach will cultivate better health, reduce delivery of unwarranted care, promote patients' compliance with health improvement plans and reduce overall healthcare costs.”

"TriZetto's survey finds all constituents of U.S. healthcare in rare agreement," noted Jeff Rideout, M.D., TriZetto's chief medical officer and senior vice president of cost and quality of care. "They concur that a systematic, collaborative approach will cultivate better health, reduce delivery of unwarranted care, promote patients' compliance with health improvement plans and reduce overall healthcare costs."

Eight in 10 doctors (83 percent) believe value-based benefits (VBB), which personalize health plan co-pays and co-insurance to help individuals manage their chronic illnesses, would have a moderate to high impact on selecting care alternatives that are proven effective and cost less. Additionally:

• Seventy-four percent of healthcare payer executives say VBB would reduce overall healthcare costs; 75 percent believe it would help win more new business.
• Nine in 10 employer executives (88 percent) report that they would be encouraged to switch to an insurance company that offers VBB.
• Eighty-six percent of consumers and 88 percent of the brokers who sell health insurance policies say VBB would encourage people to be healthier and more productive.

TriZetto's study also shows broad support for value-based reimbursement (VBR), models that reimburse physicians for delivering care that complies with proven effective care guidelines, enhances care coordination and improves clinical outcomes:

• Eighty percent of physicians, 91 percent of payers, 84 percent of employers and 82 percent of brokers believe VBR is somewhat or very important in helping reduce overall healthcare costs.
• Eight in 10 doctors (81 percent) say they would participate in contracts that use VBR.
• Three-quarters of clinicians (75 percent) feel VBR would encourage their own compliance with proven best practices in treating patients.

"It is a positive sign that most clinicians are willing to participate in some form of VBR, and 57 percent already do," Dr. Rideout said. "These numbers are encouraging given that some forms of VBR, such as episode payments, are quite new and that our sampling of clinicians was skewed to specialists, who have less access to VBR models than do primary care physicians. With specific healthcare reform expectations, successful implementations and new models that bring true value creation for both physicians and payers, the conditions are favorable for more widespread adoption of VBR. Encouraging, as well, is that all healthcare constituents endorse a systematic health management approach based on an individualized and member-centric view of evidence-based care."

A systematic health management approach among clinicians, payers and consumers helps address the health and wellness needs of an entire population, whether it is a health plan's membership, an employer's workforce or a physician's patient panel. The model employs a health improvement plan for patients; a leading, or "quarterback," role for physicians in coordinating patient care; clinician reimbursement for delivering care that aligns with proven best practices; monitoring progress toward health goals; and a team approach that obtains input from clinicians, such as a patient's health coach, dietician and specialists.

Among the findings of TriZetto's study:

• Nine in 10 employers (91 percent) say this systematic health management approach can have a moderate to high impact on establishing better patient health, while 86 percent of consumers believe it can help reduce the delivery of unwarranted treatment and procedures.
• Three-quarters of clinicians (75 percent) feel that this approach can have a moderate to high impact on promoting patients' compliance with personal health improvement plans.
• Eight in 10 payer executives (78 percent) say a systematic health management approach can help reduce overall healthcare costs.

"We find the results of this study encouraging because they reinforce the importance of our Integrated Healthcare Management strategy and particularly the timeliness of our value-based benefits and reimbursement solutions," said Dan Spirek, TriZetto's chief strategy and marketing officer and executive vice president, enterprise strategy and communications. "TriZetto is uniquely able to support these solutions systematically through health plans' business processes."

Reliable at a 95-percent confidence level, TriZetto's study was conducted as a 60-day online survey. Opinion Research Corporation, a global market research firm, conducted 1,761 interviews with the following constituents: 157 healthcare payers, 200 brokers, 200 employer executives, 203 clinicians and 1,001 consumers. Health plan respondents included managers, directors and C-suite executives.