I read with great interest an article [2 week access] in Health Affairs written in part by Michael Chernew professor of health care policy at Harvard.

One feature of this design has co-pays varying inversely to the “benefit” of the service.  This would encourage those to seek out services whose benefit exceeds the cost of the service while discouraging those services (thru higher co-pays) those that do not justify.

For example, Pitney Bowes has reduced copays for all users of drugs commonly prescribed fro diabetes, asthma, and hypertension compared to copays of other conditions in order to drive care for those conditions because drugs have been shown to significantly benefit.

Although I personally think that a plan of this type has about as much chance of passing on the federal level as a flat tax, I see lots of opportunities for employers (those that are self-insured) and benefit managers (e.g. pharmacy, physical therapy) to implement and drive better care.

Let’s take an acute episode of LBP.  Perhaps if the patient chooses to go to a family practice MD, they have a $50 copay (and if imaging is involved an additional $50) but if they go to a PT who is trained in EBP they pay $5.

What do you think?

Larry