The High-Value Services Hierarchy
- 1Preventive care: USPSTF A/B services, ACIP vaccines, HRSA women's services — $0 cost-sharing required by ACA
- 2Chronic disease medications: Diabetes, hypertension, asthma, heart disease — reduce or eliminate cost-sharing
- 3Primary care visits: Low or $0 copay reduces ER utilization and improves care coordination
- 4Mental health services: Low cost-sharing improves access and reduces downstream medical costs
- 5Telemedicine: $0 or low copay reduces ER and urgent care visits
- 6Maternity care: Prenatal care programs reduce high-risk pregnancy costs
Chronic Disease Medication Cost-Sharing
Reducing cost-sharing for chronic disease medications is one of the highest-ROI VBID interventions. Studies show that even small increases in medication cost-sharing significantly reduce adherence — and non-adherent patients have dramatically higher hospitalization rates. A diabetic patient who stops taking their insulin because of cost will likely end up in the ER.
IQ Insight
The Pitney Bowes VBID program reduced cost-sharing for diabetes and hypertension medications to $0. The result: medication adherence increased by 15–20%, hospitalizations decreased by 20%, and total cost of care decreased despite the lower cost-sharing. The investment in reduced cost-sharing paid for itself many times over in avoided hospitalizations.
Mental Health as a High-Value Service
Mental health services are among the highest-value services in the employer health plan. Employees with untreated mental health conditions have medical costs 2–3x higher than those without, and significantly higher rates of absenteeism and presenteeism. Low cost-sharing for mental health services improves access and reduces downstream medical costs.