OHLC

Our Value-Based Benefits initiative provides a model for health benefits that encourages a cost-effective approach to prevention, chronic care management and preference sensitive treatments.

The model provides a three-tiered level of benefits. Here is a summary (download the full benefit design):

Tier One—Coverage is provided with no or minimal co-pay responsibility for eligible members, for a set of benefits for six chronic conditions: coronary disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, asthma and depression. Tier One benefits reduce costly and unnecessary emergency room visits and hospitalizations by removing the financial barriers that may prevent individuals with chronic conditions from receiving timely care. Coverage for proven preventive services can also be covered as a tier one benefit.

Tier Two—Currently covered services offered at the standard deductible, co-insurance and stop loss that is now in place for most plans.

Tier Three—Coverage is provided for health services that are nationally recognized as overused and driven by provider preference or supply rather than evidence-based need. These treatments sometimes offer little clinical value at the population level and, at worse, can be potentially harmful for patients. While covered these services will be subject to a higher deductible, co-insurance and stop-loss or out-of-pocket maximum.

Updates on our work:

Commitments to Value-Based Benefit Designs Fulfilled

Value-Based Benefit Designs are now being offered by all health plans that had committed to offer them when this initiative was first launched.

The health plans are:

New Employer Offering a Value-Based Benefit Design

Legacy Health introduced a new value-based benefit design for their 7,700 employees beginning Jan. 1, 2012. The design has the same basic principles as the Council’s initial design, with adaptations that align with Legacy’s mission. With dependents, this plan covers more than 16,000 Legacy employees and dependents.