Value-based insurance design, or value-based benefits design, is a newer approach in health insurance with one main goal in mind. This benefits design works to offer employees access to high value care. High value care is simply care that provides the best health results for patients and at the best price. This benefits design is meant to help with both overuse and underuse.

Overuse of health insurance and benefits is viewed as inappropriate care—oftentimes this looks like unnecessary and unneeded tests or procedures because the doctors and hospitals order these tests to be done. This is fee-for-service medicine, but slowly, value-based design is beginning to take over. Underuse is not seeking medical attentions, getting regular checkups and tests, or skipping essential screenings because they are inconvenient and costly.

An article from The Commonwealth Fund states that Americans receive only about 55 percent of the recommended care, but at the same time $700 billion in health care services are delivered each year which don’t offer improvement in health. That is a lot of underuse and overuse, and this is what the value-based insurance design it aiming to change.

A value-based benefits design could help your company save money and get your employees to only seek medical attention when it is necessary, allowing them to get the care they need, see actual results, and save money. At Rittenhouse Benefits LLC, we can help small businesses explore their options and tailor a benefits program that fits the needs of their employees and organizations.

Our experts can help you find the perfect programs to implement into your value-based benefits design, allowing your employees to get what the need to make the best health decisions. Some of these programs include telemedicine, health risk management, wellness programs, medical price transparency, and patient advocacy.

According to Families USA, a value-based benefits design could be used to both reduce or eliminate cost-sharing for high-value care and increase the cost sharing for low-value care. When high-value care has reduced cost-sharing, patients can get the right care that offers the best results, and at the right price. Patients can get evidence-based care from high-quality providers that is known to improve health outcomes and help prevent future problems.

When low-value care costs are increased, it means that patients will receive care that may offer little to no clinical results. These treatments may also not be any more effective than less expensive treatments, and could be delivered by low-quality and inefficient providers.

With reduced cost-sharing for high-value care and increased cost-sharing for low-value care, patients will have more incentives to used the high-value service, meaning that their treatments will offer better results and cost less, saving them additional trips to medical providers and avoiding worsened health problems in the future.

The key of value-based insurance design is to encourage patients to seek the medical attention they need and to ensure they get high-quality care that will actually provide results. The Commonwealth Fund article mentions an example of how this type of benefits program helped save money and still allow employees to get the care they need:

“Colorado Springs School District 11, with 3,400 employees, made an aggressive push to discourage open surgery when minimally invasive (laparoscopic) alternatives were available. The district targeted five common surgeries and provided incentives to members that opted for laparoscopic vs. open surgery. Employees responded enthusiastically and the district saved at least $1 million on hospital and surgical costs. Continued savings of about 2 percent of overall medical costs continue to accrue.”

The programs offered at Rittenhouse Benefits LLC can help increase your organization’s access to care, help make it more affordable, and allow employees to make better health care decisions.


One of the programs we use in a value-based benefits design is telemedicine. This program can help to reduce the amount of emergency room and urgent care visits. With this program as part of your benefits design, your employees will be able to contact a certified physician over the phone. Often times, these physicians can diagnose any health problems and prescribe a treatment. This can help in many ways. If an employee can be diagnosed over the phone, they will not have to make the trip to a health care provider.

Health Risk Management

Health risk management offers different features that can help your organization and cover your employee’s needs. These features include employer health opportunity assessment, health screening programs, health coaching programs, as well as many more. With these different elements of health risk management, your organization could alter your value-based benefits design to fit your needs and cover all of your employees.

Health screening programs allow for companies to diagnose their employees who have undiagnosed medical conditions. By diagnosing these health concerns, employees can get them treated early and prevent future problems. This goes back to the high-quality care that can help improve conditions now and in the future. Health coaching is another program that is offered from Rittenhouse Benefits. With health coaching, certified coaches will talk with your staff and determine individual health goals. These coaches will work with your employees to ensure these goals are being met.

The health risk management program is designed to help keep your employees as healthy as possible. With health screenings, assessments, and coaching your employees can work towards a healthier lifestyle, allowing them to avoid visiting health providers as often, which will save them money. These programs are used to improve the health of people with different conditions that require a lot of care.

Wellness and Disease Management

Along with health risk management, Rittenhouse Benefits LLC also has a wellness and disease management program to help your employees make improvement on their health and lifestyle. We offer incentive strategies, user friendly tools, and employee communication that helps get your staff on board with this program. We offer:

  • Year-round wellness- these are self-directed campaigns that increase employees awareness, knowledge, and engagement, helping employees take action to improve their own health.
  • Wellness assessments- get employees personal health and behavior information to measure health risks and willingness to change.
  • Preventive screening- give employees basic information about their health, helps to show improvement over time.
  • Health coaching- our team helps your employees make goals and work towards them.

A value-based benefits design can help your organization save money, help reduce underuse and overuse of benefits, and can allow your employees to get the best possible care for the best price. This type of benefits design could help your business majorly and could even improve the health of your employees. If you are looking for a new program for your health benefits, Rittenhouse Benefits LLC can help. Contact us today to learn more about our VBID and get your questions answered.