Value-Based Insurance Design: Clinically Nuanced Consumer Cost-Sharing for Mental Health Services

Background: While consumer cost-sharing is a widely used strategy to mitigate health care spending, numerous studies have demonstrated that even modest levels of out-of-pocket cost are as-sociated with lower use of medical care, including clinically nec-essary, high-value services. Within mental health care, increases in cost-sharing are associated with reductions in use of mental health care and psychotropic medication use. Further, these reductions in mental health services and treatments can lead to downstream con-sequences including worsening of psychiatric illness and increased need for acute care and psychiatric hospitalization. Thus, there is a need for clinically informed solutions that explicitly balance the need for appropriate access to essential mental health services and treatments with growing fiscal pressures faced by public and private payers. Value-Based Insurance Design (VBID) describes a model where consumer cost-sharing is based on the potential clinical bene-fit rather than the price of a specific health care service or treatment. Aims of the Study: Describe value-based insurance design and ap-plications in mental health care. Results, Discussion and Implications for Health Policies: For over two decades, clinically nuanced VBID programs have been im-plemented in an effort to optimize the use of high-value health ser-vices and enhance equity through reduced consumer cost-sharing. Overall, the evidence suggests that VBID has demonstrated success in reducing consumer out-of-pocket costs associated with specific, high value services. By reducing financial barriers to essential clini-cal services and medications, VBID has potential to enhance equity. However, the impact of VBID on overall mental health care spend-ing and clinical outcomes remains uncertain.