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President Signs Defense Bill Authorizing TRICARE V-BID Pilot On Friday, December 23rd, 2016, the President signed a $619 billion defense bill that calls for a pilot program to demonstrate and test the feasibility of incorporating Value-Based Insurance Design into the TRICARE program.  The pilot aims to improve health outcomes and enhance the experience of care for U.S. Armed Forces military personnel, military retirees, and their dependents. Section 701:  (1) IN GENERAL -- Not later than January 1, 2018, the Secretary of Defense shall carry out a pilot program to demonstrate and assess the feasibility of incorporating value-based health care methodology in the purchased care component of the TRICARE program by reducing copayments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers under such purchased care component, including by exempting certain services from deductible [...]

December 6, 2016 - Senate Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., along with Senators Johnny Isakson, R-Ga., and Mark Warner, D-Va., co-chairs of the Finance Committee Chronic Care Working Group introduced S. 3504, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016, 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 SEC. 301.  ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.  (h) NATIONAL TESTING OF MODEL FOR MEDICARE ADVANTAGE VALUE-BASED INSURANCE DESIGN - (1) IN GENERAL - In implementing the model described in paragraph (2) proposed to be tested under section 1115A(b), the Secretary shall revise the testing of the model under such section to cover, effective not later than January 1, 2019, [...]

2017 Defense Bill Calls for Expanded Role for V-BID in TRICARE Program House and Senate conferees have agreed to an almost $619 billion defense budget that calls for a demonstration using Value-Based Insurance Design in the TRICARE program.  The National Defense Authorization Act for fiscal year 2017 is tentatively scheduled for a House vote Friday and a Senate vote soon thereafter, senior staffers told the press on December 1st.  Text of the conference report - Page 454: (1) IN GENERAL -- Not later than January 1, 2018, the Secretary of Defense shall carry out a pilot program to demonstrate and assess the feasibility of incorporating value-based health care methodology in the purchased care component of the TRICARE program by reducing copayments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers under such purchased [...]

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]

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 [...]

  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 [...]

Today, the House Republicans released their Report from the Health Care Reform Task Force, a white paper outlining a number of policy proposals they believe will lower health care spending and deliver higher quality care.  Notably, the proposal recommends allowing for the implementation of value-based insurance design (V-BID) throughout Medicare Advantage (see full text below) as a potential solution to 'one-size-fits-all' deductibles, copayments, and coinsurance. This expanded role of V-BID in the Medicare Program builds on bipartisan legislation that passed in the House last summer (HR 2750), the CMS MA-VBID demonstration project set to begin in seven states this January, and the inclusion of V-BID principles in Section 2713 of the Patient Protection and Affordable Care Act that requires the elimination of consumer cost-sharing for specified preventive care services. Report Language Page 33:  "Today's traditional fee-for-service (FFS) Medicare program isolates beneficiaries from the true cost of health care.  For example, Medigap policies provide something called first-dollar [...]