The Smarter Health Care Coalition’s mission is to enhance the patient experience – encompassing access, convenience, affordability, and quality – by working together towards achieving smarter health care, with a focus on integrating benefit design innovations and consumer/patient engagement within broader delivery system reform in order to better align coverage, quality, and value-based payment goals.

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Who we are

The Smarter Health Care Coalition is a forum for learning and innovation that allows participants to brainstorm, raise ideas and issues, and find common interests in the pursuit of smarter care.  Our Coalition built off of research and momentum sparked by Professor Mark Fendrick of University of Michigan, Director of the Center for Value Based Insurance Design and Professor Mike Chernew of Harvard Medical School, and has grown to currently consist of a broad-based and diverse group of health care innovators, including health plans, life science companies, employer groups, provider-related organizations, trade associations, academia centers and professors, foundations, and consumer groups.

These participants include:

Aetna America’s Health Insurance Plans American Benefits Council American Heart Association ♦ American Osteopathic Association  Amgen Blue Cross Blue Shield Association Blue Shield of California CAPG Centene  Evolent Health ♦ Institute for Medicaid Innovation Medicaid Health Plans of America  Merck National Center for Medical-Legal Partnership National Coalition on Health Care Novo Nordisk Pfizer Pharmaceutical Research and Manufacturers of America Public Sector HealthCare Roundtable U.S. Chamber of Commerce University of Michigan Center for Value Based Insurance Design

A key Coalition goal is to better align innovations in benefit and coverage design with efforts in payment and delivery system reform. Aligning these efforts creates a critical opportunity to increase patient access to care with high clinical value, particularly when linked to broader approaches to encourage person-centered engagement.  Creating these linkages is a key area of interest that transcends each of our issue areas.

More specifically, a growing body of peer-reviewed evidence demonstrates that cost sharing and benefit design can play an important role in ensuring access to and appropriate utilization of high-value care.  The Smarter Health Care Coalition believes that smart innovation in benefit design focused on providing access to services with high clinical value not only creates opportunity for greater alignment with payment and delivery system reform, but also, and most importantly, increases efforts towards effective management of chronic conditions. By enhancing access to services with high clinical value, these innovations can positively affect health outcomes for many Americans, and consequently, healthcare spending overall.

Medicare Advantage

The Coalition supported efforts that advanced a VBID demonstration in Medicare Advantage that will begin in 2017. The Coalition will continue to work with CMMI as various aspects of the demonstration are developed, implemented, and evaluated for potential learning, diffusion, and expansion.

Read our  Statement of Support

Additionally, read our comments to the Senate Finance Committee Chronic Care Working Group.

For more information about the demonstration, read our VBID in MA overview here


Currently, the Coalition is focusing its efforts on applying value-based insurance design concepts to expand the Preventive Care Safe Harbor, particularly to ensure access to high value services aimed at managing chronic conditions.

For background on this issue, the Coalition’s suggested approach, and a legal opinion on the Treasury’s ability to expand the Preventive Care Safe Harbor, read more here

Cadillac Tax

The goals of the Cadillac tax should be seen in the broader context of payment and delivery system reforms, which are increasingly focused not only on costs, but also on how wisely we choose to spend our health care dollars and understanding the relative clinical value that different services provide.

Read our Cadillac Tax discussion document here .

State-Based Purchasing

The Coalition is interested in exploring the connection between state-based reforms and the provision of health benefits with the themes generally advanced by the Coalition.

Legislative Work Group

The purpose of the congressional and regulatory outreach group is to assist in coordinating various Coalition activities on the Hill and with the Administration to most effectively build on Coalition participant relationships and discussions towards advancing consensus goals.

 For more information or to become more specifically involved in our efforts, please contact us

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