Insurers might get a better “return on investment,” or ROI, when they spend money on improving care for workers with individual health coverage than when they spend money on improving care for members of traditional employer health plans.
“Value-based care” refers to efforts by health coverage sponsors and providers to spend more on care that improves patients’ lives and less on other kinds of care.
The task force helps health insurers, health care providers, advocacy groups and other groups share ideas for improving the U.S. health care system. The list of members includes Aetna, Blue Shield of California, Kaiser, the American Heart Association and Families USA.
Workers with ICHRAs can use cash from their employers to buy their own individual health coverage.
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Workers with ICHRAs may support value-based care efforts by choosing plans that use value-based strategies to make coverage better and cheaper, the task force says.
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The task force says ICHRA plans could also boost value-based care efforts by helping workers stay with the same health insurer longer.
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Workers with traditional employer-sponsored insurance, or ESI, usually change insurers when they change employers, the task force says.
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When workers use ICHRAs, they “may remain on a plan longer than on a typical ESI plan,” the task force says. “ICHRAs may facilitate longer-term ROI on [value-based care] because coverage is not tied to employment. Even if an individual switches plans within an ICHRA, they remain in the individual risk pool, which provides greater predictability and stability for the health system overall.”
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Brokers and value-based care: Benefits brokers and benefits consultants could be an obstacle to value-based care adoption, the task force says.
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Today, the task force says, “brokers are often paid between 2% to 8% of the premium paid by plans and employers, and benefit consultants are often paid between 0.5% and 2% of spending on health care services by employers.”
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Brokers may not always talk about their compensation, and they may not disclose compensation arrangements that discourage them from recommending value-based care arrangements, the task force says.
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Employers should “demand broker accountability based on value, not volume,” the task force says.
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But, even when brokers are enthusiastic, well-informed supporters of value-based care, they may have trouble helping employers compare value-based contracting options, because health plans have no widely accepted standards for describing value-based care contract options, the task force says.
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In some cases, the task force says, brokers may recommend high-tech services that do promote value-based care but are too expensive for small and midsize employers.
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If brokers recommend value-based care services that require patients to talk to people other than their usual doctors, that could cause new problems, by making it harder for patients to find and get care, the task force warns.
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