Objective: The purpose of this paper is to describe the philosophy and utility of value-based
designs (VBDs), with an eye toward defining a pathway for a shift to VBDs across US
businesses involved in the health care discussion.
Methods: A 12-question survey of 36 companies that had been identified as emerging leaders
in health and productivity management was administered by telephone interview and,
later, by online interview. Information collected included company size, business
sector, prevention, wellness, data accessibility and integration, condition management,
C-suite visibility, and culture of health. Answers were scored on a scale from 1 to
10 per category; the maximum score was 50 points. These scores were used to indicate
patterns of development and define the pathway to maturity. Experts resurveyed the
data to quantify change over time, which was used as a proxy for dividends. A pathway,
or continuum, was graphed based on the scoring.
Results: Three segments were found to be clearly correlated with the reported experiences
from the surveys—patterns of data use, targeted population change, and services and
metrics. The movement through the continuum begins with a focus on prevention and
wellness across the entire population, next uses data to identify current waste (inefficiencies
in specific segments of the population regarding chronic care, accessibility, and
quality/reimbursement, and inefficiencies in care delivery), and finally merges the
total health and wealth of segments of the population into one coordinated strategy
to maximize the total health value of every dollar spent at the individual and system
Conclusions: The market for VBDs has grown rapidly. The pathway to success—including the data
needed, designs created, services acquired to change behavior, and dividends over
time—can be shown to be replicable, scalable, and sustainable.