From the National Business Coalition on Health: Drs. Mark Fendrick and John Ayanian argue that in order to shift health care spending from volume-based to value-based, payment models must consider certain “clinical nuances.” The authors conclude that "By basing consumer cost sharing on the clinical value – not the price – of services, payers can actively engage consumers in seeking high-value care and foster more regular conversations with providers regarding low-value services."
Examples of "clinical nuance" include:
"An example of using clinical nuance to make health plans more efficient is the evidence-based recommendation that individuals with diabetes undergo routine eye examinations. While it is not clinically appropriate for everyone to receive such exams, the delivery of this evidence-based service to patients with diabetes is a frequently employed quality metric. In a nuanced design, cost sharing for eye exams would be substantially lower for those with diabetes than for those without."
"More recently, V-BID (value-based benefit designs) programs have incorporated nuanced disincentives to discourage the use of low-value care. Key stakeholders, such as the medical professional societies participating in the Choosing Wisely initiative, agree that discouraging the misuse or overuse of identified low-value services must be part of the strategy. These “stick” programs, while more difficult to implement, are substantially more likely to achieve short-term cost savings."
Read more about why to introduce clinical nuances into your benefit design.
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