Value-Based Care for Diabetes Does Not Increase Costs

October 18, 2017

A poster presented at AMCP Nexus 2017 found that implementation of a value-based plan design did not significantly impact costs compared to standard benefit design.

“The CDC states 20% of health care spending is for people with diagnosed diabetes,” 

Patrick Gleason, PharmD, director of health outcomes at Prime Therapeutics, and colleagues wrote. “To encourage optimal diabetes drug therapy, a value based insurance design lowering members’ diabetes drugs cost share to zero has been recommended by academics and consultants.”

The researchers sought to study how lowering patient cost sharing would impact overall plan costs for payers. They measured medical and pharmacy benefit costs for patients receiving insulin for a single copay compare to patients in a standard plan design.

The researchers used integrated pharmacy and medical claims data from 2015 for 8,128 members with diabetes in the value based plan design compared data to 97,536 members with diabetes in a standard plan design. The patients in the value-based plan were started on the reduced cost sharing in 2009.

Study results showed that total cost of care was 7.9% lower among patients in the value based plan design, with $16,086 per member per year costs compared to $17,465 in the standard plan design group. They also found that pharmacy costs were %15.3 higher among value based design members; however, these costs were offset by medical benefits costs that were 18% lower among patients with diabetes in the value-based care design.

“Within a large commercial fully insured population providing a diabetes value based insurance design for many years, there was no difference in total cost of care compared to a matched population with standard benefits when the background cost differences were assessed,” Dr Gleason and colleagues concluded.

David Costill