Value-Based Insurance Designs In response to rising spending, employers and insurers have sought to identify benefit designs that would simultaneously reduce spending and improve the health of beneficiaries. These goals can conflict. For example, increasing deductibles appears to reduce use of services and therefore costs. Unfortunately, patients appear to reduce use of effective and ineffective services, often including preventive care that is covered in full (Agarwal, care had improved and some had not. Only modest evidence about quality and safety has been analyzed. For this highly inte-grated system, PCMHs appear to contribute to realizing the Triple Aim. Can becoming a PCMH help other practices realize the Triple Aim?
Green and colleagues suggest that the evidence is clearer than it seems. Their analysis focused on conditions that were targeted by Blue Cross Blue Shield of Michigan and measured how many PCMH components each practice had implemented (which had seldom been done before). Their analysis found that emergency department costs and hospitalization costs fell for all conditions but fell by much more for targeted conditions and for practices with more complete PCMH implementation. An earlier study that analyzed data for only two years of PCMH implementation found that full implementation was associated with higher quality and significant cost reductions for adults. Partial PCMH implementation was associ- ated with higher quality but not with cost reductions. A separate study found that the patient experience was rated more highly in PCMH prac- tices