[EQ] Using Evidence to Design Benefits

Research Insights:

Using Evidence to Design Benefits

National Health Policy Conference (NHPC) in Washington, D.C. in February 2010, AcademyHealth

Available online at: http://bit.ly/b7uYPD

“…………Whether evidence-based research fuels the broad reforms in health care delivery that are essential to improving quality and reining in health care costs will depend not only on the strength of research efforts but also on the development of effective strategies to integrate evidence into decisions about how people use health care.

 

Evidence-based purchasing programs rely on a broad variety of benefit design strategies, including strategies for determining “essential” or “core” benefits. They can provide ways to link insurance design to provider performance, e.g., adherence to evidence-based practice. Evidence-based benefit designs create incentives—in the form of either financial incentives or enhanced services—that drive consumer behavior.

 

The goal is to encourage people to use services that are effective and provide clinical benefit for the money spent. As the application of evidence-based designs advances, payers and policymakers will face trade-offs between the specificity of benefit structures and administrative efficiency. “Getting it right” can be technically difficult and expensive as well as politically problematic.

 

Evidence to-date suggests the need for research to address concerns related to establishing expectations about the standards for evidence in support of decisions about what insurance should pay for, determining how to expand the use of evidence to broader categories of health benefits, and developing a better understanding of how different types of incentives work with different populations…………”

 

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