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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 [...]

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 [...]

As Washington grapples with the fate of the Affordable Care Act, a pair of health care researchers has proposed a new way to design health insurance plans [...]