Q. Value-based benefit design seems to be gaining traction at the employer, health plan and government policy level. Please tell me what it's all about and where you see this trend going.

A. We understand that when people talk about benefits, they primarily look at the insurance design. But the reality is the levers that cause people to change their behaviors can be with the insurance plan design or it may be an incentive or a disincentive that's put in place and that stands outside the regulatory environment. When we began and launched the Center, there were a handful of companies that were experimenting around value-based design and my business partner, Jack Mahoney, was one of those architects of a value-based design at Pitney Bowes. What we've now learned is what this market place was and how much impact we could have is now too big to influence. We can no longer identify how many folks are doing the value-based design because most companies, particularly, those above 5,000 employees are doing some form or value-based design. The market place still thinks that a value-based design is about co-pays or waivers about co-insurance for pharmaceutical intervention. That is one small slice of a benefit design, but a value-based design can be focused on individual health improvement, life-style improvement and wellness. It can be focused on care delivery, and it can be focused on chronic care management, of which pharmaceutical reduction can be a part if it's applicable.