Pursuant to § 38.2-3462 of the Code of Virginia (Code), beginning on or after January 1, 2021, each health carrier offering or renewing a health benefit plan in the small group market in Virginia must develop and implement a Comparable Health Care Service Incentive Program (referred to in this report as the “Shared Savings Program") providing incentives for covered persons1 (referred to as “enrollees" in this report) to shop for comparable health care services from health care providers that are paid less than the average in-network allowed amounts for that service.

In 2024, eight Virginia health carriers participated in the program. These health carriers reduced their allowed costs of $755,633 to paid costs of $326,878, for a reduction of $428,755. They paid $56,015 in incentives to participating enrollees, for a net savings of $372,740. On average, participating enrollees received $46 in incentives, or 13 cents in incentives for every $1 reduction in carrier-paid costs.

When viewed over a 3-year period, carrier savings have leveled out for the last two years, reaching 57% of the original allowed in-network amounts before incentive payments in 2024. Participant benefits have fluctuated, with savings passed to participants at 14% in 2022, dropping to 11% in 2023, then rising to 15% in 2024. Participation has fluctuated significantly over the 3-year period, with a sharp increase from 15,873 participants in 2022 to 50,521 in 2023, followed by a decrease to 25,274 in 2024. The program's penetration averaged 17% of covered persons in the small group market over the 3-year period.

Overall, the data from the Shared Savings Program continues to show cost savings for both participating carriers and enrollees, with carriers averaging 52% savings before incentive payments and 45% after incentive payments over the 3-year period.