What is Engaged Benefit Design?
Engaged Benefit Design (EBD) is a new approach to healthcare benefits that provides resources and incentives for patients and their healthcare providers to make healthcare decisions based on patient values and medical evidence. Treatments with stong scientific evidence to support their use, such as prenatal care and insulin to treat diabetes, are called "No Co-Pay, High Value," and are available at no additional cost to the patient. Other treatments, that may be right for some but not for others, are called "Costs More, Learn More." A patient and a provider may choose these treatments but there is additional expense to the patient. Free-of-charge educational material is available to encourage consideration of alternatives before making a final decision. You may be eligible for a gift card or other incentive just for learning more about your options.
Why was Engaged Benefit Design created?
Healthcare costs too much and far too often patients do not receive care that is based on good scientific evidence of its effectiveness. By identifying treatments with very good evidence (No Co-Pay, High Value) and encouraging their use combined with the identification of treatments that are frequently of very limited value to the patient (Costs More, Learn More), EBD supports better choices that may lead to improved health and lower cost.
How will Engaged Benefit Design change my health plan?
EBD does not replace the health plan selected by your employer. Instead it modifies a benefit plan with the goal of improving patient's care without raising cost. It does so in three ways: co-pay for high-value services are waived, low-value services have a surcharge, and patients are provided with decision aids to help them make a good decision along with their provider.
Who selected treatments on the "No Co-pay, High Value" and "Costs More, Learn More" lists?
The Engaged Benefit Design Medical Advisory Council created these two lists. Members include top physicians and healthcare experts. It was led by Dr. Dave Downs, Medical Director of Engaged Public, and Past President of the Colorado Medical Society. For a list of members click here.
Who paid for the development of Engaged Benefit Design?
Engaged Benefit Design is supported by a combination of public and philanthropic funding. The concept was developed and nurtured by the Dr. A.J. Kauvar Foundation, based in Denver, Colorado. The current work of the project is paid for by a grant from the Health Resources and Services Administration, US Department of Health and Human Services, which is administered by the Colorado Department of Health Care Policy and Financing. Additional funding focusing on consumer engagement has been provided by The Robert Wood Johnson Foundation.
Can anyone use Engaged Benefit Design?
Yes. It is meant to be a publicly available approach to improve healthcare quality and value. It is designed to be easily adaptable to existing insurance benefit packages. However, the identified treatments and the system of support are not intended to be used piecemeal. In order to protect the integrity of the careful work that has gone into Engaged Benefit Design, please contact Engaged Public, the entity that has led its development, to inquire about support for using this approach.
Does Engaged Benefit Design decrease the cost of healthcare?
EBD does not change the cost of healthcare services. However, Engaged Benefit Design will support choices that take advantage of the highest quality research and the experience of leading physicians. Some research suggests that the higher co-pays and educational material provided for treatments in the "Costs More, Learn More" category will reduce utilization and save money. However, the elimination of co-pays for services in the "No Co-pay, High Value" category is likely to increase utilization of these proven treatments. While it is the hope that EBD will slow the growth in overall healthcare spending, that question will be unanswered until it has been tried and evaluated.
Has Engaged Benefit Design been tested anywhere?
The first implementation begins on January 1, 2012 with the employees and dependents of the San Luis Valley Regional Medical Center in Alamosa, Colorado. The plan is being administered by San Luis Valley HMO. The Colorado Health Institute is evaluating the program.
What is the "No Co-pay, High Value" list?
Treatments that have been designated "No Co-pay, High Value" have excellent evidence to support their use. In order to encourage their use for those conditions there is no cost to you for using them.
What is the "Costs More, Learn More" list?
Treatments that have been designated "Costs More, Learn More" may be right for some people and in some circumstances but not in others. For most of these treatments, there is evidence that they are overused or misused. Most of the items on this list are covered by your plan but they have a significant surcharge. A few procedures are excluded from coverage. The surcharge is intended to serve as a "speed bump" in the process of making a decision, sending a message to slow down, learn about all of your options, and then make a decision with your caregiver. "Patient Decision Aids," are available as an educational resource for most of the "Costs More, Learn More" and "No Co-pay, High Value" treatments. When prescribed by a provider, patients who complete PDAs can receive a gift card.
What is shared decision-making?
The Informed Medical Decisions Foundation uses this definition: "Shared decision making is the process by which a health care provider communicates to the patient personalized information about the options, outcomes, probabilities, and scientific uncertainties of available treatment options and the patient communicates his or her values and the relative importance he or she places on benefits and harms. Shared decision making has been widely advocated as an effective means for reaching agreement on the best strategy for treatment." Click here for more information.
What is a PDA?
Patient Decision Aids (PDAs) are educational tools, including videos and booklets, that have been developed to help consumers make decisions about their healthcare. Engaged Benefit Design partners with the Informed Medical Decisions Foundation and Health Dialog to offer a wide selection of PDAs. To view an example on the use of the PSA test to screen for prostate cancer, click here. Patient Decision Aids are important resources in shared decision-making with your care provider.
Can I sign up for a different plan that does not use Engaged Benefit Design?
You may sign up for an alternative plan if your employer offers. Contact your human resources department for more information.
What is Preference-Sensitive Care?
Preference-Sensitive Care refers to treatments that may be right for some people but not for others depending on their individual goals and values regarding risks and benefits of available options for their care. Click here for an article from the Center for the Evaluative Clinical Sciences at Dartmouth for more information.
What is Supply-Sensitive care?
Supply-sensitive care refers to treatments that may be performed, in whole or in part, based on the supply of medical resources (e.g. hospitals, physicians, testing equipment, etc.) rather than what a patient needs medically and rather than their preferences. According to the Center for the Evaluative Clinical Sciences at Dartmouth, "Where there is greater capacity, more care is delivered – whether or not it is warranted." EBD seeks to empower consumers and create an informed basis for shared decision-making with providers to curb supply-sensitive care. Click here for more information.
Do I have to use the treatments identified as high-value?
No, but if you do, you can be assured that there is good evidence that they will improve your health. In addition, you will not have a co-payment.
Does this approach take away my choices about my care?
For the most part, EBD increases your choices by providing more information about alternatives, including their risks and benefits, and supports use of high value services by removing co-pays. However, a very small number of services are added to those already excluded in a typical benefit package based on scientific evidence that they provide little or no benefit for certain conditions.
Does Engaged Benefit Design reduce spending on healthcare, and if so how?
There are solid reasons to believe that Engaged Benefit Design will reduce overall healthcare spending, but it has not yet been demonstrated. A pilot is underway that will provide helpful information about cost savings. If the educational and benefit design features of EBD reduce the use of over- and misused treatments ("Costs More, Learn More") there should be cost savings. However, because consumer cost sharing is eliminated for the highly effective treatments in "No Co-pay, High Value," utilization of those services may increase, which could increase cost. (Over the long-term, greater access to "No Co-pay, High Value," services may save money because people will be healthier.) EBD is currently being pilot tested and evaluated to answer these questions, and the results will be made public. However, one thing is clear, EBD will produce more health per dollar spent, producing more value for your healthcare dollar.