Low premiums yet big bills – why high-deductible health plans need reform
Low premiums yet big bills – why high-deductible health plans need reformThis article was originally published on The Conversation.By Betsy Q Cliff, University of Michigan and A. Mark Fendrick, University of MichiganA few years ago, we met Angie, a hair salon owner in Oregon with health insurance coverage and a stack of unpaid medical bills. She and her husband were both employed – he as a carpenter — and earned about US$45,000 a year, a bit less than the median income in their county. They were raising two children. Their health insurance had a deductible of US$4,000 for each person, capped at US$8,000 for the family, which meant they had to pay that much before benefits would kick in.Angie said she had been putting off needed medications for a chronic endocrine disorder and other medical care because they couldn’t afford to pay more on top of the [...]
Growing momentum for V-BID in Medicare Advantage plans
Responding to growing momentum for clinical nuance in Medicare Advantage, the V-BID Center has provided substantial comments on the recent CMS RFI regarding a V-BID demonstration project in Medicare Advantage (MA) and Medicare Advantage prescription drug plans (MA-PD). These comments contain explicit, evidence-based recommendations to address some of Medicare’s most complex challenges regarding effective benefit design features, cost-sharing parameters, consumer/provider engagement methods, quality measures, actuarial value considerations, among other topics, while also exploring potential barriers to implementation. This RFI capitalizes on ongoing interest in V-BID at the federal/legislative level. Earlier this September, US Senators John Thune (R-SD) and Debbie Stabenow (D-MI) introduced legislation S.2783: The V-BID for Better Care Act of 2014. The bipartisan, bicameral bill directs the Secretary of Health and Human Services to establish a three-year demonstration program allowing participating MA plans to test V-BID principles of reduced copayments and coinsurance for high-performing providers, evidence-based [...]
V-BID submits comments to CMS RFI on Medicare Advantage
In response to the recent CMS RFI regarding implementing V-BID in MA, MA-PD plans, the V-BID Center has submitted comments substantively exploring this option. We hope that you will share this document with interested parties. Please feel free to comment on this document or contact us if you would like additional information.
Fendrick Elected to Institute of Medicine
Monday, October 20, 2014. Washington, DC. Today, the Institute of Medicine (IOM) announced that V-BID Center Director, A. Mark Fendrick, MD, has been elected to join its membership. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Established in 1970 by the National Academy of Sciences, IOM has become recognized as a national resource for independent, scientifically informed analysis and recommendations on health issues. For additional details, read the official University of Michigan Health System press release.
V-BID Director on ‘Understanding Healthcare with Paula Zahn’
V-BID Center Director, Dr. A. Mark Fendrick was recently a featured guest on “Understanding Healthcare with Paula Zahn.” Both the preview and full-length episode are available online.
Seizing Opportunity to Provide Clinical Nuance in Medicare Advantage
Medicare provides health insurance to 54 million elderly and disabled Americans. Enrollment is expected to increase rapidly in coming years, as 10,000 baby boomers becoming eligible for Medicare each day. However, without action, the costs of Medicare—both per enrollee and growth in spending—threaten the program’s solvency. While predictions are less dire than previously expected, there is still much work to be done to align spending, quality, and care. Currently, enrollees in Medicare fee-for-service (FFS) face a “one-size-fits-all” approach to cost sharing. However, Medicare Advantage (MA) plans offer a unique opportunity to break out of the current mold of fee-for-service delivery and payment. As outlined in a V-BID brief on Medicare Advantage, private health plans have flexibility to use care management techniques to promote evidence-based, high value network formation, high performing provider-facing interventions (e.g., bonuses for quality and high performance), and utilization management programs to identify under-utilization as [...]
V-BID included in CMS Request for Information to Innovate Medicare
Thursday, October 2, 2014, Washington, DC. The Centers for Medicare & Medicaid Services (CMS) released a request for information to innovate Medicare Prescription Drug Plans (PDP), Medicare Advantage (MA) and Medicare Advantage Prescription Drug Plans (MA-PD), Medicaid managed care plans (Medicaid plans), Medigap plans, and Retiree Supplemental health plans. Specifically, CMS requests information on innovations in: ● Plan design, including but not limited to value-based insurance design ● Care delivery; ● Beneficiary and provider incentives and engagement; ● Network design. This request coincides with the recent introduction of bipartisan, bicameral legislation to authorize a V-BID demonstration project in Medicare Advantage.
AJMC Editorial on Generic Cost Sharing Generates Attention
On Wednesday, September 17, 2014, The American Journal of Managed Care published an editorial by Dr. A. Mark Fendrick, V-BID Center Director, and Dr. Gerry Oster, Vice President of Policy Analysis Inc. The piece, also featured in the New York Times Upshot, details a recent pharmacy benefits management trend in which several prominent health plans are forcing consumers to assume more of the burden of their health care costs by placing generic drugs into "preferred" and "non-preferred" tiers. This parallels the split that one typically finds with branded drug pricing. As a result, many patients now face substantially higher co-pays for various generic drugs -- many of which are recommended as first-line treatments for several chronic conditions and auto-immune diseases. The authors contend that the designation of these generic drugs as "non-preferred" based on cost alone may result in lower rates of medication and treatment adherence, which runs counter [...]
V-BID for Better Care Act of 2014 Introduced in US Senate: “Transformative” Idea Attains Bipartisan, Bicameral Support
Washington, D.C. September 11, 2014 - U.S. Senators John Thune (R-South Dakota) and Debbie Stabenow (D-Michigan) introduced bipartisan legislation The Value-Based Insurance Design (V-BID) for Better Care Act of 2014 (S.2783). A summary of S.2783 is available. A companion bill, H.R. 5183, was introduced by House Representatives Diane Black (R-Tennessee) and Earl Blumenauer (D-Oregon) in July. Specifically, the bipartisan, bicameral bills direct the Secretary of Health and Human Services to establish a three-year demonstration program allowing participating Medicare Advantage plans to test V-BID principles of reduced copayments and coinsurance for high-performing providers, evidence-based medications, or clinical services related to specific chronic disease care, while explicitly prohibiting plans from increasing copayments or coinsurance to discourage use of services. The clinical and economic impact of the demonstration project will be evaluated. Expansion of the project depends on whether implementing V-BID plans that provide clinically nuanced incentives for beneficiaries with chronic conditions [...]
Value-Based Insurance Design Better Care Act Introduced to Congress
July 23, 2014Washington, D.C. - Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) introduced H.R. 5183 - The V-BID for Better Care Act of 2014 to establish a regional demonstration program for Medicare Advantage plans that allows the utilization of Value-Based Insurance Design (V-BID) to reduce beneficiary cost-sharing for selected high-value prescription medications, providers, and clinical services related to chronic disease care. A summary of the bill and official release are available. A companion bill, S.2783 was introduced in the Senate in September of 2014.Specifically, the bipartisan, bicameral bills direct the Secretary of Health and Human Services to establish a three-year demonstration program allowing participating Medicare Advantage plans to test V-BID principles of reduced copayments and coinsurance for high-performing providers, evidence-based medications, or clinical services related to specific chronic disease care, while explicitly prohibiting plans from increasing copayments or coinsurance to discourage use of services.Evidence is accumulating that V-BID programs improve quality, reduce disparities, and in some circumstances, lower [...]