expenditures, access to care, and clinical outcomes is also reviewed, with gaps in knowledge and future areas of needed research identified.

Approaches such as pharmaceutical or hospital tiering programs have attempted to increase the transparency of value of different medical interventions and providers. Dennis Scanlon describes in further detail how tiering classifies healthcare providers, pharmaceuticals, or treatments on the basis of objective or subjective criteria such as cost, quality, and value, and engages patients and consumers in making informed decisions. One example discussed in detail is a hospital tiering program and the impact of the program on consumer choices and quality of care.

Concluding the session, Ronald Goetzel details the value of worksite health promotion and chronic disease prevention programs, indicating that they can yield significant health and economic benefits for employers and employees. In addition to discussing how workplace wellness programs can serve as vehicles for health behavior change, he outlines recommendations to increase employer engagement in providing evidence-based health promotion programs to their employees.

VALUE-BASED INSURANCE DESIGN: RESTORING HEALTH TO THE HEALTHCARE COST DEBATE

A. Mark Fendrick, M.D., University of Michigan Medical Center, and Michael E. Chernew, Ph.D., Harvard Medical School


As healthcare premiums escalate, both private and public purchasers are forced to decide how best to address this unsustainable economic burden. Unfortunately, value—the clinical benefit achieved for the money spent—is frequently excluded from the dialogue on how to manage the growth of healthcare spending.

If the desirable clinical effects of health insurance are ignored, constraining healthcare cost growth can be achieved simply by providing less generous coverage or no coverage at all. In fact, the numbers of Americans who are uninsured or underinsured is at an all-time high, reflecting the trade-off between the high cost of health benefits and remaining viable in today’s economy (Kaiser Family Foundation, 2005). Although rising healthcare costs are the main impetus behind the redesign of health benefits, concerns regarding the quality of care share the limelight. This clear and unresolved tension between cost containment and suboptimal quality of care has led to two prevailing trends in benefit design:

  1. Cost containment strategies that use financial incentives to alter patient and provider behavior: This approach includes increases in cost sharing (e.g., deductibles, copays, coinsurance rates) in exist-



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