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Government Funding Bill Expands MA V-BID Model Test to All 50 States On February 9, 2018, President Trump signed the Bipartisan Budget Act of 2018.  The funding bill incorporates the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which includes the expansion of the CMMI Medicare Advantage Value-Based Insurance Design (V-BID) Model to all 50 states.  The model allows Medicare Advantage plans the flexibility to reduce cost-sharing or offer supplemental benefits to enrollees with specified chronic conditions, focusing on the services that are of highest clinical value to them. SEC. 50321: Adapting Benefits to Meet the Needs of Chronically Ill Medicare Advantage Enrollees."(h) National Testing of Medicare Advantage Value-Based Insurance Design Model-"(1) In General - In implementing the Medicare Advantage Value-Based Insurance Design model that is being tested under section 1115A(b), the Secretary shall revise the testing of the model under such section to cover, effective not later than January [...]

On Thursday, February 8th, 2018, Senators John Thune (R-SD) and Tom Carper (D-DE), and Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR), introduced the Chronic Disease Management Act of 2018 (S.2410 and H.R. 4978) in the House of Representatives and the Senate.  The bipartisan bill states,  "Allowing health savings account-eligible high-deductible health plans to cover chronic disease prevention and treatment on a pre-deductible basis promotes the concept of Value-Based Insurance Design, which is an effective tool to improve the quality and reduce the cost of care for Americans with chronic diseases, with improved outcomes via increased medication adherence, reduced complications, and decreased emergency department visits."The bill amends IRS Section 223 (c)(2)(C):(a) IN GENERAL—Section 223(c)(2) of the Internal Revenue Code of 1986 is amended by redesignating subparagraph (D) as subparagraph (E) and by inserting after subparagraph (C) the following new subparagraph: ‘‘(D) SAFE HARBOR FOR ABSENCE OF DEDUCTIBLE FOR [...]

New V-BID Center Video Details How Precision Co-Pay Assistance Programs Enhance Access to Clinically Indicated Therapies  Consumer cost-sharing for prescription drugs is high and getting higher.  To address the high out-of-pocket medication costs, patient assistance programs, such as co-pay cards, have become available to reduce consumers' financial liability.  However, the use of co-pay assistance for medications for which there is an effective, lower-cost alternative is deemed as financially burdensome to the healthcare system. To counteract this inefficiency, Accumulator Adjuster Programs - which prevent co-pay assistance funds from being applied to patients' deductibles - are increasingly being implemented, resulting in greater patient financial responsibility and potential disruption of recommended treatments. Our new "Precision Co-Pay Assistance Program" whiteboard video introduces a clinically nuanced solution designed to ensure access to clinically indicated therapies. V-BID Center Director, A. Mark Fendrick, MD, is available for questions or comments at vbidcenter@umich.edu or (734) 615-9635. [...]

  On November 30, 2017, the National Academy of Sciences, Engineering, and Medicine released a long awaited report on access and affordability of prescription drugs. The report, "Making Medicines Affordable: A National Imperative", includes a key recommendation to the   V-BID Center: Congress also should direct the Centers for Medicare & Medicaid Services to modify the designs of plans offered through Medicare Part D and government health insurance exchanges to limit patients’ out-of-pocket payments for drugs when there is clear evidence that treatment adherence for a particular indication can reduce the total cost of care, as determined by HHS. To read more about V-BID and Medicare Advantage, view the resources below.                                

CMS ANNOUNCES UPDATES TO MA V-BID MODEL TEST On November 22, 2017, the Centers for Medicare and Medicaid Services (CMS) announced updates to the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The model launched on January 1, 2017, at which time select MA plans in 7 states were permitted to offer varied benefit designs for enrollees diagnosed with specified clinical conditions.  In 2018, the model will expand to three new states and will add two clinical categories. Beginning in 2019, the V-BID model will expand to an additional fifteen new states for a total of 25 states, allow Chronic Condition Special Needs Plans to participate, and allow participants to propose their own systems or methods for identifying eligible enrollees.   The MA-VBID 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 [...]

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 [...]

  New Alexander-Murray bipartisan bill includes V-BID Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached an agreement on Tuesday, October 17th regarding their bipartisan bill to fund key insurance subsidies.  The cost-sharing reduction payments reimburse insurance companies for lowering deductibles, co-payments and other out-of-pocket costs for low-income customers.  Page 11 of the draft bill language includes a section on value-based insurance designs: "(iii) waivers encouraging or requiring health plans in such State to deploy value-based insurance designs which structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services;" Value-Based Insurance Design (V-BID) is a potential solution built on the principle of lowering or removing financial barriers to essential, high-value clinical services and providers.  V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services.  These innovative programs are designed with the tenets of clinical nuance in [...]

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 [...]

September 26, 2017 - Today, the United States Senate passed S. 870,  Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, a bipartisan bill to strengthen and 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. BILL SECTION 301.  ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES UNDER MEDICARE ADVANTAGE.  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 for its enrollees exceed program payments and [...]