Summary: Value-based insurance design (VBID) has emerged as a potentially viable approach to promote healthcare value. VBID abandons the traditional approach of uniformly applying cost sharing to health services regardless of their effect on a patient’s health. Instead, VBID tailors cost sharing to the value that the service provides the beneficiary in terms of health gained per dollar spent. The more clinically beneficial the service is to a patient, the lower that individual’s cost sharing for the service. Given the growing need to increase the value of care delivered in the Medicare program and the existing evidence suggesting that VBID can generate cost savings and improve health outcomes, there are clear opportunities to explore how to implement VBID within the Medicare program. This analysis presents options for advancing a VBID approach within Medicare’s prescription drug benefit (Part D), and specifically focuses on differential cost sharing for chronically ill beneficiaries and high-value medications that target chronic conditions.

For centuries the criminal justice system has struggled to define the methodology of and the justifications for social control of sexual behavior that does not conform to community mores. This poster compares and contrasts the historical and contemporary attempts in the United States, Canada, Belgium, the United Kingdom, and Germany to address the risk created by individuals who engage in behaviors broadly characterized as sexually deviant. Where available, we consider the rationale for sentencing, and the earliest attempts to bring “treatment” into the criminal dispositional formula for sexual based prosecution. We also consider the impact that the choice of societal response has on risk assessment and evaluation in the various systems, including where available, the assessment and commitment of juvenile offenders. The current practice of civil commitment for a person deemed to be a sexually violent predator (SVP) is discussed highlighting the U.S. Supreme Court decision in Kansas v. Hendricks. This practice will then be compared and contrasted with the approach of designating an offender as a Dangerous Offender (DO) or a Long-Term Offender (LTO) under the criminal law. We also highlight sex offender registries where applicable. This poster is intended as an overview of the law as it exists, and not as a defense or a critique of any specific model.