Value-Based Insurance Design: Aligning Incentives, Benefits, and Evidence in Oncology

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  • a Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
  • | b Comprehensive Cancer Center and Committee on Clinical Pharmacology and Pharmacogenomics and Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois
  • | c Department of Internal Medicine and Health Management & Policy and Center for Value-Based Insurance Design, University of Michigan Medical School, Ann Arbor, Michigan.
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When everyone is required to pay the same out-of-pocket amount for oncology services for which benefits depend on patient characteristics and clinical indication, there is enormous potential for both under- and overutilization. Unlike most current health plan designs, the value-based insurance design (V-BID) explicitly acknowledges and responds to patient heterogeneity across the entire continuum of cancer care. By adding “clinical nuance” to benefit design, V-BID encourages the use of services when the clinical benefits exceed the cost, and likewise discourages the use of services when the benefits do not justify the expenditure. This manuscript further describes the concept of V-BID, creates a framework for its development in oncology, and outlines how this concept aligns with ongoing research, care delivery, and payment reform initiatives.

Correspondence: Jonas A. de Souza, MD, The University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2115, Chicago, IL 60637-1470. E-mail: jdesouza@medicine.bsd.uchicago.edu
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