The VBID Implementation Roadmap
- 1Analyze claims data to identify high-value and low-value service categories
- 2Prioritize interventions by ROI — start with chronic disease medications and ER cost-sharing
- 3Design the cost-sharing changes and confirm MHPAEA compliance
- 4Negotiate plan document and vendor contract changes
- 5Develop member communication explaining the changes and why they were made
- 6Implement and measure outcomes quarterly
- 7Refine the design based on outcomes data
Measuring VBID Outcomes
- Medication adherence rates for chronic disease medications
- ER utilization rates for non-emergency conditions
- Hospitalization rates for chronic disease patients
- Total cost of care for targeted disease categories
- Member satisfaction with the plan
- Utilization of targeted high-value services (preventive care, telemedicine)
Communicating VBID Changes
Pro Tip
VBID changes that reduce cost-sharing are easy to communicate — employees appreciate paying less. VBID changes that increase cost-sharing for low-value services are harder to communicate. Frame these changes in terms of clinical evidence: "We are increasing the ER copay for non-emergency visits because the same care is available at urgent care for less — and we want to make sure your healthcare dollars go further."