CalPERS unveils updated Value Based Insurance Design for PPO Gold members

The CalPERS Board Meeting held on March 18, 2025, focused on critical discussions surrounding healthcare benefits for members, particularly the Value-Based Insurance Design (VBID) program. This meeting highlighted the ongoing efforts to enhance healthcare quality and affordability for California's public employees.

A significant recommendation from the meeting was to maintain the current service area and plan design of the PERS Gold plan. This decision, while not introducing new options for out-of-state members, aims to prevent adverse impacts on premiums for in-state members. The board emphasized that changes to benefit designs could lead to worse health outcomes and higher costs if members delay necessary care.

Doctor Julia Logan presented an overview of the VBID program, which aims to improve health outcomes by lowering out-of-pocket costs for high-value services. The program encourages members to engage actively in their healthcare decisions, aligning costs with the value of services received. Over the past 25 years, variations of VBID have been implemented, with CalPERS first introducing it in 2019 for the Basic PPO Gold Plan.

The current VBID structure includes several components designed to incentivize preventive care and support members with chronic conditions. Members can earn credits to offset deductibles by participating in preventive screenings, flu shots, and chronic disease programs. The board discussed plans to reassess and enhance the VBID program for 2026, including expanding the activities that allow members to earn credits.

Proposed changes for the 2026 VBID design include increasing the number of credits available for preventive care activities and introducing new engagement categories focused on mental health and chronic disease management. The board aims to align these changes with quality measures to ensure that all CalPERS members receive equitable healthcare, regardless of their plan type.

Looking ahead, the board plans to explore further refinements to the VBID strategy for 2027 and beyond, including potential adjustments to cost-sharing for doctor visits related to chronic conditions. The committee will prepare for implementation activities if the proposed modifications are approved, ensuring that members are informed ahead of the open enrollment period.

In conclusion, the discussions at the CalPERS Board Meeting reflect a commitment to improving healthcare access and outcomes for California's public employees. The proposed enhancements to the VBID program aim to foster greater member engagement and align with quality standards, ultimately striving for a healthier workforce.