In a value-based plan, the idea is to reward employees for seeking treatments that promote wellness.
The more clinically viable the treatment, the less an staff member compensates out of pocket for it.
Example – Women over 40 and younger staff members with a family history of breast cancer pay less for a yearly mammogram than staff members for whom the test isn’t as necessary.
Value-based plans often work better than high-deductible plans when used in combination with standard wellness program features such as health risk (assessment|appraisal}s.
Five target areas
According to the May 2008 issue of Simply Well, there are four quality-of-care criteria that have emerged as key benchmarks of the quality of care – health care management, preventive screenings and treatments, member service and access to care.
Areas of care that are of particular concern –
• Employees’ dependents receiving appropriate and timely childhood/adolescent immunizations
• Breast cancer screenings for female health plan enrollees, ages 52 to 64
• Diabetic staff members receiving hemoglobin A1C and LDL-C testing
• Members receiving proper referrals and treatment for mental health issues (e.g., primary care physician refers a patient to a specialist to ensure proper prescription and management of an anti-depressant medication)
• Pregnant employees receivig time and appropriate prenatal and postpartum care, and prevention of antibiotic treatment in adults with acute bronchitis.
The quality of care for many of the aforementioned issues can suffer when staff members foot too much of the bill out of their own pockets.
The hope for value-based plans is that staff members get some cost relief and obtain treatments that will reduce costs in the long run.
