Millions of Americans could benefit from expanded coverage of preventive services under health savings account-qualified high-deductible health plans, says new research from the University of Michigan Center for Value-Based Insurance Design and Harvard University Medical School.

Under current IRS regulations, HDHPs allow primary preventive services, as defined by the Affordable Care Act, to be available to beneficiaries at no cost and before the deductible. But “there have always been concerns that when individuals face high deductibles, they will not purchase essential health benefits such as those we’d like to see made available before the deductible,” says Mark Fendrick, M.D., director of the University of Michigan Center for Value-Based Insurance Design. “It is our strong belief that these expanded HDHPs will mitigate the concerns we have about cost-related non-adherence.”

For example, a person living with diabetes enrolled in an HDHP must pay out-of-pocket for medically necessary treatment such as blood pressure and cholesterol checks, eye and foot exams, and glucose monitoring services – until the deductible is reached and insurance coverage begins. In the report, the researchers recommend that the IRS change its current narrow guidance on “prevention” for insurers and employers so that targeted secondary preventive benefits could be covered under the deductible in HDHPs. This would provide them with greater flexibility in designing plans better tailored to the needs of the chronically ill and those at risk, say the researchers.

Also see: New Jersey health system sees results with V-BID

“Because of an IRS guidance that doesn’t allow you to put secondary preventive or treatments of chronic disease before the deductible, V-BID prinicples cannot be included in those plans,” says Fendrick.

The study developed and priced hypothetical HDHPs that incorporated value-based insurance design principles to better meet the needs of chronically ill patients and those at high risk for developing chronic conditions.

“We set out to look what might be the clinical and economic effects of a hypothetical V-BID HSA hybrid plan if it were to be allowed, under a new IRS guidance,” explains Fendrick. Allowing secondary preventive services such as diabetic eye exams would increase premiums between 5-6%, according to the research, but simulation models also showed the introduction of an expanded HDHP would result in significant incremental HDHP adoption in commercial insurance markets.

“There is real multi-stakeholder, bipartisan interest in the V-BID idea,” says Fendrick. “V-BID is essentially the targeted removal of financial barriers for evidenced-based services. This regulation that came out of the IRS basically made it impossible for these products to cover high-valued treatment that slow the progression and prevent complications of chronic diseases. … If this regulation were to expand the definition of prevention to include not only those things that prevent the disease, but also reduce the complications of the diseases, the products are clearly improved.”

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