V-BID's updated member profile and policy brief describe the Center's history, current private/public sector implementation measures, and future directions as a member of the University of Michigan's Institute for Healthcare Policy and Innovation.
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 [...]
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 [...]
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.
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 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.
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 [...]
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.
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 [...]
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 [...]
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 [...]
V-BID in action: Michigan Medicaid Expansion February 25, 2014 In September 2013, Michigan became the 25th state to expand Medicaid under the Affordable Care Act. The new Healthy Michigan Plan will provide coverage to an additional 470,000 residents over the next several years. Among the provisions of Public Act 107 of 2013, the Healthy Michigan Plan relies on V-BID to improve access, control costs, and enhance personal responsibility. Read more in our newest V-BID Brief: Michigan Medicaid Expansion. Incorporating V-BID into the Healthy Michigan Plan follows the recent CMS rule giving Medicaid programs greater flexibility to vary enrollee cost-sharing for drugs as well as certain outpatient, emergency department, and inpatient visits. When V-BID principles are used to set enrollee cost-sharing levels, Medicaid programs can improve quality of care, remove waste, foster consumer engagement, and mitigate the legitimate concern that non-nuanced cost-sharing may lead individuals to forgo clinically important [...]
Washington, D.C. February 21, 2014 -- The CMS Innovation Center issued a 2015 call letter seeking to partner with private payers to test innovations including - but not limited to - V-BID, beneficiary engagement, incentives, and/or care coordination to lower costs and improve quality for Medicare, Medicaid and CHIP beneficiaries (Section begins on page 113). A new blog post from the Association of Health Care Journalists (AHCJ) is available. The University of Michigan Center for Value-Based Insurance Design leads in research, development, and advocacy for innovative health benefit plans.
February 21, 2014 - We are pleased to announce that Representatives John Dingell (D-MI) and Diane Black (R-TN) will convene a briefing on the role of V-BID in Medicare on Capitol Hill, Friday, February 28th. Center Director, A. Mark Fendrick, MD, will present V-BID as an incremental solution to the health and economic well-being of Medicare Beneficiaries and all Americans. Understanding how the Medicare system could spend more efficiently and improve the health of beneficiaries offers an important step forward to ensure the program's solvency. V-BID has been included in major bipartisan health reform proposals, including a prominent role in the Wyden-Isaacson 'Better Care, Lower Cost Act' introduced last month. Value-Based Insurance Design (V-BID) programs are designed with the tenets of clinical nuance in mind. Clinical nuance recognizes that 1) medical services differ in the amount of health produced, and 2) the clinical benefit derived from a [...]
January 15, 2014 WASHINGTON, D.C. - Today, U.S. Senators Ron Wyden, D-OR, and Johnny Isakson, R-GA, and U.S. Representatives Erik Paulsen, R-MN, and Peter Welch, D-VT, introduced legislation to improve care coordination for the millions of Medicare beneficiaries with multiple chronic conditions and to expand the use of multi-disciplinary health teams to keep patients as healthy as possible in their homes and communities. The Better Care, Lower Cost Act of 2014 (S.1932) creates the voluntary "Better Care Program" (BCP) that is open to Medicare enrollees suffering from chronic conditions. BCPs have the ability to lower cost-sharing on services and provider visits that provide the most value for an enrollee's chronic conditions, the basic premise of Value-Based Insurance Design (V-BID). Participating plans and practices would receive newly calculated risk-adjusted, capitated payments rewarding better health outcomes for enrolled beneficiaries. A press packet and summary of the bill are also available. The University of Michigan Center for Value-Based Insurance [...]
