When optimized, health benefit plans support your goals of improving health outcomes and decreasing costs.
Health Plan Benefit Design and its Impact on Patient Behavior
Is your health plan designed in a way that jeopardizes meeting the goals of improved health outcomes and decreasing costs? Does you plan incentivize members to pursue high value care over low value care, utilizing the principles of Value Based Insurance Design (see here and here)? Does you plan cover low-cost preventive care before minimum deductibles are met as allowed by the preventive care safe harbor? If your plan is designed to incentivize members to pursue high-value care and avoid low-value care, how well is it working? Is your plan incentivizing use of biosimilars when appropriate?
A clinical perspective can help you in your efforts to ensure your plan design supports your goals and help assess if it is working as intended.
