This interactive timeline highlights the history of Value-Based Insurance Design (V-BID) from the conception of clinically nuanced cost-sharing to the implementation of V-BID principles into private and public health plans across the country.
Thursday, October 27, Senate Finance Committee Chairman Orrin Hatch, R-UT, and Ranking Member Ron Wyden, D-OR, along with Senators Johnny Isakson, R-GA, and Mark Warner, D-VA, co-chairs of the Finance Committee Chronic Care Working Group, released a discussion draft with bipartisan proposals to improve health outcomes for Medicare beneficiaries living with chronic conditions. Among the recommendations is the expansion of the Medicare Advantage V-BID demonstration to plans in any state: Section 301. Adapting Benefits to Meet the Needs of Chronically Ill Medicare Advantage Enrollees Under Medicare Advantage (MA) private health plans are paid a per-person monthly amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll. Unlike original Medicare, where providers are paid for each item or service provided to a beneficiary, an MA plan receives the same capitated monthly payment regardless of how many or few services a beneficiary actually uses. The plan is at-risk if aggregate costs [...]
Ann Arbor, MI -- If you've tried to see a doctor, fill a prescription or get a diagnostic test lately, you've probably had to pay more out of your own pocket than you would have even a few years ago. Most insurance plans have increased [...]
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation is announcing refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.
Increasing enrollment in high-deductible health plans paired with a health savings account (HSA-HDHP) is changing the health insurance landscape. As outlined by the U.S. Treasury Department, specific preventive services, such as vaccinations and screenings, may be covered prior to satisfaction of the plan deductible. However, services meant to treat "an existing illness, injury or condition" are excluded from coverage until deductibles are met. Several recent reports draw attention to increases in annual deductibles, HSA-HDHP enrollees paying more out-of-pocket and foregoing chronic disease care. A bipartisan bill was recently introduced to change Internal Revenue Service rules to allow plans to better cover clinical services for chronic medical conditions before plan members have met their deductibles. This legislation has been endorsed by: AHIP, American Benefits Council, American Heart Association, American Stroke Association, American Osteopathic Association, BlueCross BlueShield Association, Families USA, Merck, National Coalition on Health Care, Pfizer, Public Sector HealthCare Roundtable, The Smarter Health Care Coalition, and West Health Institute. [...]
On September 20, 2016, the Health Affairs Blog published a post that highlights the importance of reducing low-value health care in the United States.
Access to prescription drugs is a hot-button health care issue. Committing to policies that encourage lower cost, first-line drugs -- while ensuring access to clinically appropriate therapies -- necessitates a 'dynamic' approach to consumer cost-sharing. 'Reward the Good Soldier' is a novel benefit design that lowers consumer cost-sharing for those who diligently follow the required steps to manage their condition, but require additional treatment. Supported by the National Pharmaceutical Council, our latest V-BID Center Brief, "A 'Dynamic' Approach to Consumer Cost-Sharing for Prescription Drugs," highlights that individuals with clinical conditions often need multiple therapies to achieve desired patient-centered outcomes. A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID Center, is available for questions or comments. The resources below are also available for review: [/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]
A 'Dynamic' Approach to Consumer Cost-Sharing for Prescription Drugs Access to, and levels of spending on, prescription drugs has become an important public policy issue. Given the significant individual and population health gains that result from the appropriate use of prescription drugs, as well as the fiscal concerns pertaining to the escalation of health care expenditures, the development and implementation of patient-centered solutions that allow access to medications at an affordable cost are of critical importance. One common strategy that health care purchasers employ to control pharmaceutical spending is to increase consumer cost-sharing. This trend -- seen for nearly all drugs across all formulary tiers -- has proceeded regardless of the clinical benefit provided by a specific drug, with cost-sharing increasing as rapidly for high-value drugs (e.g., included in evidence-based guidelines) as for drugs deemed unnecessary or potentially harmful. 1 As consumers are asked to pay a [...]
V-BID in Action: The Role of Cost-Sharing in Health Disparities The existence of health disparities among specific populations has long been recognized; substantial variations in health insurance coverage, access to providers, use of specific clinical services, and patient-centered outcomes among different groups are well documented. Differences in levels of medical knowledge and information sources, trust and skepticism, participation, social support, and resources can vary significantly by population demographic. Adverse effects on health care equity have also been shown to be the result of clinician judgment, healthcare facility characteristics, and cultural milieu. A robust evidence base has determined that the causes of these disparate outcomes are multifactorial; including race, ethnic group, income, education, and age. It is difficult to attribute blame to any single factor, as many of the predictors are inextricably linked.1 A systematic review of extensive published research documenting the scope of disparities and summary of proposed potential [...]
On August 10, 2016, the Center for Medicare and Medicaid Innovation announced changes to the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The MA-VBID model test is set to begin in January 1, 2017, at which time selected MA plans in designated states will be permitted to offer varied benefit designs for enrollees diagnosed with specified clinical conditions. In 2018, the model will expand to Alabama, Michigan, and Texas, and will add two clinical categories: rheumatoid arthritis and dementia. For additional information about the CMMI MA V-BID model program, please visit the model website: innovation.cms.gov/initiatives/vbid/ Our latest White Paper, supported by the Gary and Mary West Health Policy Center, draws attention to the growing problem of cost-related non-adherence in Medicare and explores how clinically nuanced cost-sharing can mitigate adverse patient-centered outcomes. Actuarial modeling reveals that Medicare Advantage plans that reduce cost-sharing for high-value services for select chronic conditions [...]
Shifting the health care system from “volume-to-value” has become a common theme in health care reform discussions. Benefit designs that engage consumers in their health care, while also encouraging access to high-value and appropriate care, are of particular interest.
Health Information Technology & V-BID: A Synergistic Combination IntroductionValue-Based Insurance Design (V-BID) is an innovative approach that can improve clinical outcomes and contain costs. The basic premise of V-BID is to align consumer incentives with value by reducing barriers to high-value health services and providers (‘carrots’) and discouraging the use of low-value health services and providers (‘sticks’). When ‘carrots’ are coupled with ‘sticks’ in a clinically nuanced manner, V-BID improves health care quality and controls spending growth. The concept of clinical nuance recognizes that: 1) medical services differ in the benefit provided; and 2) the clinical benefit derived from a specific service depends on the patient using it. This brief examines how the incorporation of V-BID principles into health information technology (HIT) can enhance the potential for HIT to improve quality and increase efficiency.Interoperable HIT systems, meaning systems with the capability to “talk to each other” by exchanging [...]
Washington, D.C.-- Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) introduced H.R. 5652 "Access to Better Care Act of 2016." This bill provides high deductible health plans the flexibility to provide coverage for services that manage chronic disease prior to meeting the plan deductible. The bipartisan bill amends Section 223(c)(2) of the Internal Revenue Service (IRS) Code. Currently, in health savings account-qualified high deductible health plans (HSA-HDHPs), services meant to treat "an existing illness, injury or condition" are excluded from coverage before the plan deductible is met. Evidence is accumulating that individuals enrolled in high deductible plans may not utilize essential services to manage chronic conditions due to the high cost. As chronic conditions make up 75 percent of total U.S. health spending, appropriate disease management is an important tool to improve patient-centered outcomes and, in some cases, lower long-term health care costs. As the market for HSA-eligible HDHPs grows, it is important that [...]
This month's news update features support for V-BID on Capitol Hill, continued momentum for the alignment of payment and benefit design, and a research agenda to address low-value care.
