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Millions of Americans suffering from chronic diseases could save money on the drugs and medical services they need the most, if their health insurance plan decided to take advantage of the benefits. a new federal rule published today.
And the idea behind this rule was born at the University of Michigan.
Today, the US Treasury Department has given health insurers greater flexibility to cover the cost of certain drugs and tests for people with common chronic conditions who are enrolled in many high-deductible health plans.
The change in rules is due in part to research and more than a decade of political commitment by A. Mark Fendrick, professor at U-M, and his colleagues at the U-M Center for designing value-based insurance.
Approximately 43% of adults who take out health insurance through their employment benefit from a high-deductible plan that requires them to spend at least $ 1,300 before their insurance covers their care, or $ 2,600 they cover their family members.
People with high deductible health care plans usually have to pay for the full cost of the services used to manage chronic conditions, such as asthma inhalers, blood glucose tests, and blood tests. insulin for diabetes, as well as drugs to treat depression and hypercholesterolemia. We have reached their deductible plan.
More than half of them have access to a special type of health savings account at the tax shelter to save on their health costs, and some employers contribute to these. accounts.
But until now, the federal tax code specifically prevented high-deductible plans with health savings accounts, or HSA-HDHP, from covering drugs and services for common chronic conditions up to 39 that the registrants fill their franchises. Such coverage may reduce the likelihood that people with chronic diseases will skip preventive care because of cost and improve long-term outcomes.
Meanwhile, the 2019 Bipartite Chronic Disease Management Act was introduced in the Senate and House of Representatives last month with the same goal of reducing direct costs for Americans with chronic diseases facing high deductibles. .
A. Mark Fendrick, Professor, U-M Medical School and School of Public Health
While more and more Americans are facing high deductibles, they are struggling to pay for their essential medical care. Our research has shown that this policy has the potential to reduce direct costs, reduce federal spending on health care, and ultimately improve the health of millions of people with chronic diseases. We have been actively advocating for this policy shift for more than a decade. "
Fendrick is a physician in internal medicine at Michigan Medicine and a member of the U-M Institute for Health Policy and Innovation.
Specific coverage for specific registrants
The new rule designates 14 services for people with certain conditions that high-deductible health plans can now cover pre-deductible.
The list closely matches that presented by the V-BID Center in a 2014 badysis. This report, based on clinical evidence available at the time, shows that these tests and treatments could help people with chronic diseases to manage their health and detect or prevent an aggravation of their disease, at a lower cost.
The list includes:
- ACE inhibitory drugs for people with heart failure, diabetes and / or coronary artery disease
Bone-strengthening medicines for people with osteoporosis or osteopenia
Beta blockers for people with heart failure and / or coronary artery disease
Sphygmomanometers for hypertensives
State-of-the-art inhalers and flow meters for asthmatics
Insulin and other medicines to lower blood sugar in diabetics
Eye Screening, Glucose Meters and Long-Term Glucose Testing for People with Diabetes
Tests for blood clotting ability in people with liver disease or bleeding disorders
LDL cholesterol tests in heart patients
Antidepressants called SSRIs for people with depression
Statins drugs for people with heart disease and / or diabetes
The new Treasury guidelines also leave the door open in the future to allow higher-deductible plans greater flexibility to cover other preventive services for people with these and other chronic diseases.
Fendrick and Michael Chernew, a professor at Harvard University, explained in the 2007 Journal of General Internal Medicine that regulatory changes were needed to level the playing field for chronically ill people in health care plans. high franchise health.
The V-IDB principles – based on the idea that high-value clinical services should cost the least to the people who need them the most – have also been integrated with other types of health insurance plans.
For example, Medicare Advantage plans, offered by private insurers to people over 65 and disabled, are now able to offer value-based co-payment plans. The same is true for plans offered under TRICARE, the military family insurance program, and employer-sponsored private plans without a high deductible.
The V-BID team recently introduced V-BID X, a new benefits concept designed to expand options in the individual market by improving coverage of essential medical services and medicines, without increasing premiums or deductibles.
Learn more about V-BID and high deductible health plans
In addition to his role as Director of the UM Center for Value-Based Insurance Design, Fendrick is a consultant to several public and private organizations and is the founding partner of V-BID Health, a company that badists health insurance plans and businesses. health systems in the design of health care benefit packages.
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