Opportunities for V-BID in Medicare Advantage
- Read the CMS Medicare Advantage V-BID Model program announcement
- Read the RFA for the CMS Medicare Advantage V-BID Model program
- Read the CMMI/CMS Medicare Advantage V-BID Model program FAQ
- Read the V-BID in Medicare Advantage Actuarial Guidance
- Read announcement summary for MA V-BID Model program announcement
- V-BID Medicare Advantage Bill Passes House of Representatives – Read More
On September 1, 2015, the Center for Medicare & Medicaid Innovation (CMMI) announced a program to test Value-Based Insurance Design (V-BID) in Medicare Advantage (MA) plans. The program will examine the utility of structuring patient cost-sharing and other health plan design elements to encourage patients to consume high-value clinical services, thereby improving quality and reducing costs.
A growing body of evidence demonstrates that increases in patient cost-sharing lead to decreases in the use of both non-essential and essential care. Medicare beneficiaries, many of whom manage multiple chronic conditions, are not removed from this phenomenon.
Due to misaligned incentives, Medicare beneficiaries receive too little high-value care and too much low-value care. Although the Medicare statute provides for coverage of certain preventive services identified by the U.S. Preventive Services Task Force (USPSTF) with zero cost-sharing, the fee-for-service (FFS) program allows little flexibility to implement clinically driven benefits.
For example, cost-sharing for all clinician visits, diagnostic tests, and prescription drugs is typically implemented in a “one size fits all” way. Under the fee-for-service Medicare program, this is the required approach.
Transitioning from a volume-driven to value-based delivery system requires a change in both how we pay for care and how we engage consumers to seek care. Value-Based Insurance Design is an innovative approach that can address this problem.
Applying clinically nuanced strategies in benefit design presents an enormous opportunity for the Medicare program–particularly Medicare Advantage (MA) plans. In contrast to FFS Medicare, private health plans participating in MA have the flexibility to use care management techniques to promote evidence-based care, including a limited ability to adjust benefit design. The compendium of MA tools includes network formation, provider facing-interventions (e.g., bonuses for quality and high performance), and utilization management programs to identify under-utilization as well as over-utilization. From the consumer engagement perspective, however, MA plans could further enhance their ability to serve beneficiaries if they had greater ability to use benefit design and clinically nuanced cost-sharing to promote value.
V-BID can encourage the utilization of high-value providers and services and limit the use of services that are of potentially low-value, thus helping Medicare Advantage plans improve health and quality, enhance consumer engagement, and reduce costs.