Regulators Put Out RFI for Value-Based Health Coverage Data

December 27, 2010 ( – Federal regulators have issued a request for information (RFI) on how group health plans and health insurers can use value-based insurance design (VBID) for recommended preventive services under the health reform law.

The health reform law and regulations issued so far apply to group health plans and health insurance issuers offering group or individual health insurance coverage that is not grandfathered and require such plans and issuers to provide coverage for recommended preventive services, without imposing cost-sharing requirements.

Issued jointly by the Departments of Labor, Treasury and Health and Human Services, the RFI asks for information on specific examples and best practices of VBID for recommended preventive services, as well as data used to support and inform VBID benefit design, measurement, and evaluation in the context of recommended preventive services. Comments are due February 28, 2011, according to the regulators’ document, and can be addressed to each of the three agencies.

Among the questions posed by the RFI were:  

  • What specific plan design tools do plans d issuers currently use to incentivize patient behavior, and which tools are perceived as most effective (for example, specific network design features, targeted cost-sharing mechanisms)? How is effective defined?
  • Do these tools apply to all types of benefits for preventive care, or are they targeted towards specific types of conditions (for example, diabetes) or preventive services treatments (for example, colonoscopies, scans)?
  • What considerations do plans and issuers give to what constitutes a high-value or low value treatment setting, provider, or delivery mechanism? What is the threshold of acceptable value?  

The RFI is scheduled to be in the December 28 Federal Register available here

More information about the regulations addressed in the RFI is at