In a value-based plan, the idea is to reward employees for seeking treatments that promote wellness.

The more clinically viable the treatment, the less an employee pays out of pocket for it. 

Example: Women over 40 and younger employees with a family history of breast cancer pay less for a yearly mammogram than employees for whom the test isn’t as necessary. Value-based plans often work better than high-deductible plans when used in combination with standard wellness program features such as health risk assessments.

Five target areas

According to the May 2008 issue of Simply Well, there are four quality-of-care criteria that have emerged as key benchmarks of the quality of care: health care management, preventive screenings and treatments, member service and access to care.

Five areas of care that are of particular concern:

• Employees’ dependents receiving appropriate and timely childhood/adolescent immunizations
• Breast cancer screenings for female health plan enrollees, ages 52 to 64
• Diabetic employees receiving hemoglobin A1C and LDL-C testing
• Members receiving proper referrals and treatment for mental health issues (e.g., primary care physician refers a patient to a specialist to ensure proper prescription and management of an anti-depressant medication)
• Pregnant employees receivig time and appropriate prenatal and postpartum care, and
  avoidance of antibiotic treatment in adults with acute bronchitis.

The quality of care for many of the aforementioned issues can suffer when employees foot too much of the bill out of their own pockets. The hope for value-based plans is that employees get some cost relief and obtain treatments that will reduce costs in the long run.