• Am J Manag Care · Jun 2020

    Observational Study

    Value-based insurance design in Louisiana: Blue Cross Blue Shield's Zero Dollar Co-pay program.

    • Xiaojing Yuan, Janet Chaisson, Dawn Cantrell, Brice L Mohundro, Mollie Carby, Milam Ford, Miao Liu, Jason Ouyang, Yuan Zhang, Heath C Williams, Benjamin V Vicidomina, Vindell Washington, and Somesh C Nigam.
    • Blue Cross Blue Shield of Louisiana, 5525 Reitz Ave, Baton Rouge, LA 70809. Email: Miao.Liu@bcbsla.com.
    • Am J Manag Care. 2020 Jun 1; 26 (6): e179-e183.

    ObjectivesTo determine whether a program that eliminated pharmacy co-pays, the Blue Cross Blue Shield of Louisiana (BCBSLA) Zero Dollar Co-pay (ZDC) program, decreased health care spending. Previous studies have found that value-based insurance designs like the ZDC program have little or no impact on total health care spending. ZDC included an expansive set of medications related to 4 chronic diseases rather than a limited set of medications for 1 or 2 chronic diseases. Additionally, ZDC focused on the most at-risk patients.Study DesignZDC began in 2014 and enrolled patients over time based on (1) when a patient answered a call from a nurse care manager and (2) when a patient or their employer changed the benefit structure to meet the program criteria. During 2015 and 2016, 265 patients with at least 1 chronic condition (asthma, diabetes, hypertension, mental illness) enrolled in ZDC.MethodsObservational study using within-patient variation and variation in patient enrollment month to identify the impact of the ZDC program on health spending measures. We used 100% BCBSLA claims data from January 2015 to June 2018. Monthly level event studies were used to test for differential spending patterns prior to ZDC enrollment.ResultsWe found that total spending decreased by $205.9 (P = .049) per member per month, or approximately 18%. We saw a decrease in medical spending ($195.0; P = .023) but did not detect a change in pharmacy spending ($7.59; P = .752). We found no evidence of changes in spending patterns prior to ZDC enrollment.ConclusionsThe ZDC program provides evidence that value-based insurance designs that incorporate a comprehensive set of medications and focus on populations with chronic disease can reduce spending.

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