MIAMI BEACH — A value-based insurance program with lower copayments significantly increased use of medications for secondary prevention among people with diabetes, compared with traditional insurance coverage, according to a prospective, controlled study.
The prescription fill rate increased by nearly 5% for metformin, by almost 9% for ACE inhibitors or angiotensin II receptor blockers (ARBs), and by more than 9% for statins among 1,777 diabetics with value-based insurance, compared with a control group of 3,273 diabetics with conventional insurance.
With value-based insurance design (VBID), copayments are lowered for procedures or medications deemed beneficial according to the evidence-based literature. At the same time, copayments are increased for services or drugs that are not well demonstrated to improve outcomes. This design, therefore, acts as both incentive and disincentive for patients to improve health outcomes and control costs, Dr. Allison B. Rosen said at the annual meeting of the Society of General Internal Medicine.
VBID also improved the other primary study outcome, medication adherence, by leading to a significant 7% increase in ACE inhibitor/ARB adherence.
Although evidence-based medicine supports the use of many secondary prevention agents for people with diabetes, underutilization remains a concern, Dr. Rosen said. High out-of-pocket costs are often cited as a culprit, and VBID might make a difference by linking patient copayments to value. “There are few rigorous studies to support these positive claims,” said Dr. Rosen of the University of Michigan, Ann Arbor.
So she and her colleagues enrolled active University of Michigan employees and their dependents with diabetes into a VBID program that reduced their copays for antihypertensive, lipid-lowering, and glucose-lowering agents starting in July 2006. The control patients were employees of other institutions or companies and their dependents with diabetes enrolled in the same managed care plan.
The prescription fill rate at baseline ranged from 53% for statins to 65% for metformin. Following implementation of the VBID program, there was a significant increase in the prescription fill rate for medications from all drug classes in the intervention group, compared with the control group: There was a 4.8% increase for metformin, a 8.5% increase for ACE inhibitors/ARBs, and a 9.3% increase for statins, she reported.
Increases in adherence were less striking. The only significant improvement relative to controls was a 7% increase in adherence to ACE inhibitors or ARBs in the intervention group. Dr. Rosen said that the limited impact was because “baseline adherence rates were quite high, surprisingly so.”
In response to a meeting attendee's question, Dr. Rosen said that for VBID to work effectively, “you cannot just lower all copays. We [also] have to increase copays for low-value interventions.” This was outside the scope of the current study but would need to be incorporated in a complete VBID program.
The study was funded by the National Institutes of Health, the University of Michigan, and the John A. Hartford Foundation.
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'You cannot just lower all copays. We [also] have to increase copays for low-value interventions.'
Source DR. ROSEN