Evidence-Based Design and Overuse

By some estimates, up to a third of health care spending in the United States is wasted, much of it on unnecessary care that evidence suggests doesn’t benefit patients who receive it. Employers can use plan design, coverage decisions, employee communications and health system engagement (e.g. centers of excellence) to encourage evidence-based care that most effectively benefits patients. Evidence-based benefit design can save money too; medically appropriate patient care is most likely to improve health, and healthy people ultimately spend fewer health care dollars.

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Featured Resources Approaches to Substance Use Disorder Treatment
Substance use disorder (addiction) is a growing concern for employers for several reasons, including the opioid epidemic, concerns about fraud, out-of-network costs, and the huge impact it has on employee health and productivity.

Evidence-Based Infertility Treatments
Provides recommendations to align infertility benefit offerings with evidence.

Low Hanging Fruit: Nine Evidence-Based Benefit Design Opportunities
Identifies top opportunities to align plan design with leading clinical evidence to steer consumers toward what works while discouraging potentially wasteful care.



Also of Interest

Blog Post: Selecting Evidence-Based Vendor Partners in the CDHP Era
Learn how to partner with strategic vendors that help employees access high quality, cost-effective, evidence-based treatments.

What Your CEO is Reading — Value-Based Contracts for Specialty Drugs
Highlights a recent news article on value-based pricing agreements, which is when manufacturers share in the financial risk if medications don't work as intended.

National Committee on Evidence-Based Benefit Design
The Committee seeks to improve quality of care and promote value by using benefit design to encourage and reward effective care and discourage ineffective care.


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