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Value-Based Insurance DesignValue-Based Insurance Design in Pulmonary Medicine: Aligning Incentives and Evidence in Pulmonary Medicine

A. Mark Fendrick, MD; Daniel C. Zank, MD
Author and Funding Information

From the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.

Correspondence to: A. Mark Fendrick, MD, North Campus Research Complex, 2800 Plymouth Rd, B16/418W, Ann Arbor, MI 48109-2800; e-mail: amfen@umich.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1712-1716. doi:10.1378/chest.12-2324
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When consumers are required to pay the same out-of-pocket amount for pulmonary services for which clinical benefits depend on patient characteristics, clinical indication, and provider choice, there is an enormous potential for both underutilization and overutilization. Unlike most current one-size-fits-all health plan designs, value-based insurance design (V-BID) explicitly acknowledges clinical heterogeneity across the continuum of care. By adding clinical nuance to benefit design, V-BID seeks to align consumer and provider incentives with value, encouraging the use of high-value services and discouraging the use of low-value interventions. This article describes the concept of V-BID; creates a framework for its development in pulmonary medicine; and outlines how this concept aligns with research, care delivery, and payment reform initiatives.


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