OBJECTIVES: The prevalence of diabetes in Philadelphia (16%) is highest among the 10 largest US cities and led to an estimated $245 billion in total costs during 2012. Enabling diabetic patients to seek preventive and medical services could help save millions of dollars per year, but a cohesive narrative about best practices in VBID that could be implemented by employers is lacking. A literature review on studies about VBID initiatives that target diabetes and the ROI of such programs was conducted to help guide employer members of the Greater Philadelphia Business Coalition on Health (GPBCH).

METHODS: A review of articles published between 2010 and the present day was conducted. Search terms included value-based insurance design, VBID, return on investment, ROI, and diabetes. Articles were excluded if they only conceptually discussed VBID.

RESULTS: A total of 40 articles were retrieved, and 16 were specific to both VBID and diabetes. 3 of the 16 studies specifically mentioned ROI. Research conclusions were mixed, ranging from suggested increases in cost to success in improved outcomes, increased access, and lowered cost. While ROI is uncertain if solely framed in financial terms, there is a strong case for ROI in health. Rather than focusing on saving money in healthcare, focusing on how to optimize the healthcare received for the money spent can yield a strong case for the value of investing in health. VBID concepts have been successfully used to incentivize chronic disease patients toward higher-value decisions.

CONCLUSIONS: VBID initiatives show promise in improving clinical outcomes and improving healthcare access while potentially reducing costs for diabetic patients. While it has the potential to optimize healthcare usage for the money spent, there is a need to better understand the financial implications of VBID strategies before they are widely adopted across benefit plans.