Concept born at U-M will be available to more participants, to increase choice, reduce cost and improve quality of care
The Centers for Medicare and Medicaid Services has just announced transformative updates to the Medicare Advantage Value-Based Insurance Design (MA V-BID) model. These changes aim to increase choice, lower cost, and improve the quality of care for Medicare beneficiaries.
The model launched on January 1, 2017, and has since been expanded to include 25 states, 9 chronic conditions, Chronic Condition Special Needs Plans, and allows participants to propose their own systems or methods for identifying eligible enrollees. Riding on the heels of the Bipartisan Budget Act of 2018, which included a directive to expand the model to all 50 states by 2020, today’s release makes sweeping changes to the CY2020 model, including:
- Allows plans to provide reduced cost-sharing and additional benefits to enrollees in a more targeted fashion
- Bolsters rewards and incentives programs that plans can offer beneficiaries to take steps to improve their health, permitting plans to offer higher value individual rewards
- Increases access to telehealth services by allowing plans to use access to telehealth services instead of in-person visits, as long as an in-person option remains
- Adds Regional Preferred Provider Organizations (RPPO) and all Special Needs Plans (SNPs) to currently eligible plan types
- Allows the testing of new interventions, including Value-Based Insurance Design by Condition, Socioeconomic status, or both; Medicare Advantage and Part D Rewards and Incentives Programs; Telehealth Networks; and Wellness and Health Care Planning
CMS has extended the performance period of the model by an additional 3 years, through 2024, and will allow testing of Medicare’s hospice benefit in MA beginning in 2021.
Said Alex Azar, secretary of the Department of Health and Human Services, “Expanding choices for patients, aligning incentives, and providing new flexibility for insurers in Medicare Advantage and Medicare Part D will deliver better value from these programs. The models being announced today create new incentives for plans, patients, and providers to choose drugs with lower list prices, and new ways to meet the unique healthcare needs of specific populations, prevent disease, and expand the use of telehealth. Today’s announcement draws on successes we have already seen in Medicare and advances our priority of using HHS programs to build a value-driven healthcare system.”
The MA V-BID model test aims to assess the utility of structuring consumer cost-sharing and plan elements to encourage the use of high-value clinical services and providers for beneficiaries with specified chronic conditions. V-BID approaches have increasingly been used in the commercial market, and the inclusion of clinically nuanced V-BID elements may be an effective tool to improve the quality of care and reduce the cost of care for Medicare Advantage enrollees with chronic diseases.
IHPI member A. Mark Fendrick, MD, is the developer of the V-BID concept and director of the University of Michigan V-BID Center.
Learn more about the MA V-BID Model: