TOOL Purchaser’s Guide to Value-Based Plan Design

The National Business Coalition on Health has developed a guide for employers that want to design health benefit plans that help people stay healthy. “Value-Based Benefit Design: A Purchaser’s Guide” is intended to show employers how to use their purchasing power to reduce the fragmentation and misuse of health care resources. The concept of value-based benefit design has been applied with some success by many private employers, such as Pitney Bowes and Marriott Inc., and as part of the Diabetes Ten Cities Challenge.

The guide defines value-based plan design as the explicit use of plan incentives to encourage enrollee adoption of one or more of the following:

• Appropriate use of high-value services, including certain prescription drugs and preventive services.

• Adoption of healthy lifestyles, such as smoking cessation or increased physical activity.

• Use of high-performance providers who adhere to evidence-based treatment guidelines.

The guide was developed with financial support from drugmaker Sanofi-aventis and was written by Margaret Houy, a senior consultant with Bailit Health Purchasing.