Value-based insurance design, which seeks to provide coverage and incentives for consumers to engage in healthier behaviors, is a necessary but not sufficient element of the transformation of the U.S. healthcare system from one featuring high costs, uneven quality and a population less healthy than it should be to a system providing better health, better care and lower costs. The methods by which we pay for and deliver care also must become value-based. And, perhaps most importantly, the entire system needs to shift its focus to the interconnection between the social needs and the medical needs of the population.
The American Health Care Paradox points out that the United states has the lowest ratio of social to health services expenditures of any developed nation. In Caring for Vulnerable Populations, the American Hospital Association makes the following recommendations: Hospitals should develop community partnerships with public health agencies; providers should make regular comprehensive assessments of each individual's life circumstances; and providers should adopt cultural competency and equity of care standards.
In Time to Act, the Robert Wood Johnson Foundation makes similar recommendations: Invest in early childhood development for all children; revitalize neighborhoods and fully integrate health into community development; and incent healthcare professionals and institutions to broaden their missions from treating illness only to helping people lead healthy lives.
Value-based insurance design can help in this transformation by engaging all of us in the process of staying healthier longer, along with value-based payments that encourage providers to keep us healthy rather than only treat us when we are sick, and delivery systems that do a good job of coordinating care. But a broader effort to maintain and improve the health of families, neighborhoods and communities will be essential as well.
 Bradley EH, Taylor LA. The American Health Care Paradox: Why Spending More Is Getting Less. Nov. 5, 2013.
 “Caring for Vulnerable Populations.” American Hospital Association. 2011.
 “Time to Act: Investing in the Health of Our Children and Communities.” The Robert Wood Johnson Foundation. Jan. 13, 2014.