Blue Links for Employers

Value-Based Benefits

This new approach to managing costs focuses on improving the health of members who have chronic conditions.

Value-based benefit enhancements target savings for members in areas of care shown to deliver improvements in health, lower cost, and compliance with treatment programs.

Starting January 1, 2012, these changes apply to most standard New England managed care and PPO plans available to groups with 1-99 employees enrolled. Larger employers can opt to include the Value Based Benefits in their plans.

They focus on two key areas:

Lower member cost for certain chronic disease medications. This will help minimize complications associated with non-adherence to treatment plans and to lower plan costs over the long term. It will apply to the following conditions:

  • Asthma
  • Coronary artery disease or risk for cardiovascular disease (treatment of both high blood pressure and high cholesterol)
  • Depression (when associated with asthma, cardiovascular disease risk or diabetes)
  • Diabetes
  • Smoking cessation

Eliminate cost sharing on two diabetic monitoring visits to encourage regular, proactive treatment and avoid high-cost complications.

The Power of Value-Based Benefit Enhancements

  • Increased Medication Adherence—Lower prescription drug copayments, along with health education and support, increased chronic disease treatment adherence by 15 percent in just one year (among those previously considered out of compliance).1

  • Fewer Complications—Risk of future complications and hospitalizations decreased for diabetics who were newly complaint with their drug regimens, reducing claims by up to $628 in the second year and $924 in the third year.2

Costs

Employers with 1-99 Employees Employers with 100+ Employees
0.3% of premium
1. Diabetic Management Services - Cost .2% of premium
2. Rx for Certain Chronic Conditions - Cost .1% of premium

Note:
Value Based Benefits are part of standard benefits for employers with 1-99 employees. Value Based Benefits are available on Open Plan Designs only.

Resources

 

1. Chernew, Michael E., Shah, Mayur R., Wegh, Arnold, et al. "Impact of Decreasing Copayments on Medication Adherence Within a Disease Management Environment," Health Affairs, (2008) 27: 1; and Blue Cross Blue Shield of Massachusetts 2008 data.

2. Blue Cross Blue Shield of Massachusetts 2008 data.

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