State Insurance Exchanges Face Challenges in Offering Standardized Choices Alongside Innovative Value-Based Insurance

Transparency about benefits and cost sharing, and uniform definitions and descriptions of design attributes—in plain English—will be necessary to support informed consumer decision-making.

Value-based insurance is a relatively new approach to health insurance in which financial barriers, such as copayments, are lowered for clinical services that are considered high value, while consumer cost sharing may be increased for services considered to be of uncertain value. Such plans are complex and do not easily fit into the simplified, consumer-friendly comparison tools that many state health insurance exchanges are formulating for use in 2014. Nevertheless some states and plans are attempting to strike the right balance between a streamlined health exchange shopping experience and innovative, albeit complex, benefit design that promotes value. For example, agencies administering exchanges in Vermont and Oregon are contemplating offering value based insurance plans as an option in addition to a set of standardized plans.

In the post reform environment, policy-makers must find ways to present complex value-based insurance plans in a way that consumers and employers can more readily understand.


This article, funded by the the Robert Wood Johnson Foundation (RWJF), appeared in a special issue of Health Affairs that focused on patient engagement. The issue was supported by RWJF, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.