What do you get when you combine today’s limited comparative effectiveness research with aggressive value-based insurance design? A risky and expensive proposition for patients, that’s what. I’m a fan of the value-based insurance design concept, which rewards patients and healthcare providers for using the most effective care, even if it’s more expensive. But when private insurers use it to fleece patients in a bait-and-switch scheme, it’s another matter entirely.

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We’ve been bombarded with cost containment messages this year that either make us cheer (yay! Lower premiums! Less profit!) or fear (What? Does that mean they’re going to withhold my care?) One physician leader wants to address the conundrum head-on, with a win-win proposal. Meet A. Mark Fendrick, MD, who invented a new concept a decade ago that is now under the bright spotlight of the healthcare reform debate. He calls it Value-Based Insurance Design (VBID), which tends to cause knee-jerk reactions related to rationing and 1990’s capitation. But this is about giving effective treatment, not taking it away.

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