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Value-Based Services
Commission Adopts Value-Based Services
The Health Services Commission has identified 20 sets of health care services, known as value-based services (VBS), which can be used right away by insurance companies and purchasers both in the private and public sectors. Value-based services are medications, tests, or treatments that are highly effective, low cost, and have lots of evidence supporting their use. The Commission recommends these services have no cost sharing (copays or coinsurance) to patients in order to encourage the use of these services, given their high level of benefit.
The VBS concept is based on the work of the Oregon Health Fund Board Benefits Committee, refined through a series of public workgroup and Health Services Commission meetings. Removing barriers to these effective services and treatments should help reduce higher cost interventions (like hospital admissions), leading to lower health care costs and a healthier population.
Services had to meet the following criteria for inclusion:
  • Ambulatory services (i.e. outpatient), and include medications, diagnostic tests, procedures, and some office visits
  • Primarily offered in the medical home
  • Primarily focused on chronic illness management, preventive care, and/or maternity care
  • Of clear benefit, strongly supported by evidence
  • Cost-effective
  • Reduce hospitalizations or Emergency Department visits, reduce future exacerbations or illness progression, or improve quality of life
  • Low cost up front
  • High utilization desired
  • Low risk of inappropriate utilization
Some examples of value-based services include: insulin and certain medications for diabetic patients; generic blood pressure medications and nurse case management for congestive heart failure patients; and certain generic medications and lab tests for patients with coronary artery disease.
The Commission has established VBS separate from the Prioritized List of Health Services so that this tool can be used immediately. While the VBS concept can be applied to the Oregon Health Plan (OHP), many OHP recipients already receive these services with little or no cost-sharing. Instead, it is expected that the VBS concept could have a more significant impact in the commercial health insurance market, where these services could explicitly be offered without the considerable copays or coinsurance often required now.
Similar proposals from the Health Leadership Council and the American Heart Association were examined and incorporated where applicable. The inclusion of specific health care services required high-quality supporting evidence such as Cochrane systematic reviews of randomized controlled clinical trials and evidence-based guidelines. In the future, other services will likely be reviewed, and the VBS updated annually to ensure that the most current evidence is used for designing coverage.

VBS Table
Value-Based Services Table