Value-based insurance design (VBID) promised to fix a broken incentive. It did half the job. If a diabetes medication prevents a $30,000 hospital stay, the logic goes, a patient should not pay $50 for it. Remove the copay and watch compliance rise. Employers bought in. The results are mixed.
Adherence improved for a handful of targeted drugs and medical costs dipped for some conditions, but preventive care completion rates (the upstream behaviors that stop disease before it starts) barely budged. A 2018 Health Affairs analysis found only about 8% of U.S. adults 35 and older had received all recommended high-priority preventive services. Removing a $20 copay never closed the gap. Something structurally larger was missing.
VBID is good at removing costs. It does fine work reducing financial pain at the point of care. What it does not do, and what almost no benefit design does today, is build wealth. An employee who gets an annual physical avoids a charge. An employee who skips it avoids nothing. Both land at zero. There is no asset on the other side of prevention, just the absence of a bill. That is the wealth gap in value-based design, and it explains why engagement on upstream health stays low year after year.
WellthCare™ closes that gap. It is the first Health-to-Wealth™ Benefit System, a structural redesign that works alongside an employer’s existing health plan and gets used first. Employees get $0-co-pay care, earn real, spendable reward dollars at the WellthCare Store™ for verified preventive actions, and receive automatic retirement contributions funded by program savings. The system adds no new employer out-of-pocket cost; funding comes through employee pre-tax elections and tax efficiencies. Prevention shifts from a cost-avoidance exercise into a wealth-building engine.
The three wins stack up for employees:
- Reward dollars at the WellthCare Store™ - earned instantly for verified preventive actions; spendable on 3,000+ FSA-approved, health-supporting products, with no reimbursement paperwork. Real, spendable dollars, not points.
- Automatic retirement contributions - employers commit a portion of program savings to employees’ retirement accounts, compounding over time with every healthy action.
- Out-of-pocket savings - $0-co-pay care used before the primary plan means fewer deductibles, fewer bills, and less drain on FSAs and HSAs.
Why rewards beat copay cuts
The primary plan can still apply VBID logic, lowering copays for high-value drugs or specialist visits. WellthCare adds a parallel reward layer that VBID cannot replicate. When an employee completes a health assessment, a biometric screening, or a follow-up action reviewed by a nurse practitioner and physician, reward dollars appear in their account immediately, with no lag and no form to fill out. The reward confirms the action mattered.
Behavioral economics has documented this for decades: immediate, concrete rewards carry more motivational weight than avoiding a future cost. A $0 copay removes a friction. It’s a smooth surface. A reward dollar credited to an account is a gain, something the employee can spend today while watching their retirement balance grow. That dual-earn structure changes how people engage with their own health. The design targets higher preventive completion rates, earlier condition detection, fewer large claims, and stronger retention. These are not wellness-program punch-card numbers. They are verified clinical completions, measured against standardized preventive care codes and reviewed by licensed clinicians.
Medicare's VBID model ended in 2025
The largest public test of VBID principles ended in 2025. CMS closed the Medicare Advantage Value-Based Insurance Design Model at the end of the year, citing substantial and unmitigable costs to the Medicare Trust Funds. Evaluation reports put the added cost at $2.3 billion in 2021 and $2.2 billion in 2022, with CMS pointing to higher risk scores and Part D drug spending as drivers. Lower copays changed what patients paid. They did not change the behaviors that determine whether people get sick. A benefit that only removes cost leaves that problem untouched. WellthCare's reward layer attaches value to the behavior itself.
Proof, not promises
The proof mechanism is built into the program. After six to twelve months on the WellthCare Plan, the patent-pending WellthCare Readiness Index™ produces an AI-driven report using the employer’s own claims data. It shows, with real numbers, when and how much they would save by expanding into pharmacy, Medicare, or fully integrated self-funded coverage. No industry projections, no break-even guesswork.
VBID made health plans smarter. Smarter did not make anyone wealthier. The next step is a benefit system that pays employees back for staying healthy.
See what a WellthCare Plan would look like for your team.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.