Walgreens: Value-based insurance design programs can be optimized by targeting least adherent

DEERFIELD, Ill. — Walgreens on Wednesday presented research on how value-based insurance design programs can be optimized by targeting the sickest, least adherent and most costly patients. These findings, presented at the 2014 PBMI Drug Benefit Conference in Las Vegas, examined how the VBID model can be most successful by reaching these targeted employee sub-populations.

VBID programs are emerging as a new benefit design focused on aligning patients' out-of-pocket costs, such as co-payments and deductibles, with the value of health services. The model reduces barriers to such high-value services as preventive and chronic care therapies through lower costs to patients, while discouraging unproven, misused or low-benefit care through higher costs, ultimately improving health outcomes. Studies have shown that co-payment reductions often are associated with improvements in medication adherence.

“As employers continue to look for innovative ways to manage healthcare costs while keeping employees healthy, VBID programs have emerged as a viable and effective solution,” said Bobby Clark, Walgreens director of clinical outcomes and reporting. “However, we have only just begun to look at whether these VBID programs are reaching the employees who can benefit the most from the programs. Our recent research provides new insight into how to successfully reach these sickest and most costly patients. We hope to see future studies further investigate how opt-in VBID programs can become more targeted and what the full cost, adherence and outcomes benefits will be when these programs are fully optimized.”

The Walgreens study examined an employer-based VBID program implemented in January 2010, which eliminated the co-pay for generic anti-diabetic and anti-hyperlipidemic (cholesterol) medications. Eligible members (diabetic and/or high-cholesterol beneficiaries) were required to participate in a case management or wellness program to receive the zero co-pay benefit. 

In a related study by Clark and colleagues published in the Journal of Managed Care Pharmacy, medication adherence and the costs for generic diabetes and cholesterol medications resulting from participation in a zero co-pay VBID program were examined. The zero co-pay program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. That study also demonstrated that a value-based program can have a positive impact on adherence and cost outcomes among those who participate.