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 [...]
On August 10, the Centers for Medicare & Medicaid Services (CMS) announced refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA V-BID) model. The MA-V-BID model is an opportunity for Medicare Advantage plans, including MA plans offering Part D benefits, to offer clinically nuanced benefit packages aimed at improving quality of care, while also reducing costs. In the second year of the model, beginning January 1, 2018, CMS will 1) open the model test to new applicants; 2) conduct the model test in three new states - Alabama, Michigan, and Texas; 3) add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; 4) make adjustments to existing clinical categories; and 5) change the minimum enrollment size for some MA and MA-PD plan participants. Value-Based Insurance Design (V-BID) generally refers to health insurers’ efforts to structure [...]
Washington, July 13, 2016 - According to the American College of Physicians (ACP), consumer cost-sharing, particularly deductibles, may cause patients to forgo or delay care, including medically necessary services. ACP's position paper, "Addressing the Increasing Burden of Health Insurance Cost-Sharing," recommends the implementation of value-based insurance design (V-BID) as a potential solution to make patient cost-sharing more equitable. The ACP's endorsement of V-BID builds on multi-stakeholder and bipartisan support, including the incorporation of V-BID principles in Section 2713 of the Patient Protection and Affordable Care Act requiring the elimination of consumer cost-sharing for specified preventive care services, the CMS MA-VBID demonstration project set to begin in seven states in January 2017, and the H.R. 5652, "Access to Better Care Act of 2016," that allows high deductible health plans the flexibility to provide coverage for services that manage chronic disease prior to meeting the plan deductible. Each of these programs align with the ACP's [...]
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 [...]
This month's news update features support for V-BID on Capitol Hill, continued momentum for the alignment of payment and benefit design, and a research agenda to address low-value care.
Access to prescription drugs is a hot-button health care issue. The V-BID center proposes an innovative benefit design - 'Reward the Good Soldier'.
This month's news update features a timeline outlining V-BID's history, a new video introducing a novel benefit design, and publications that support V-BID programs.
On Monday, April 4, Health Affairs reported that one state's Value-Based Insurance Design employee insurance program, which was designed to improve health while reducing costs, has successfully encouraged more use of screenings and preventive services, increased medication adherence for chronic conditions, and reduced visits to the emergency department.Researchers from the V-BID Center say, not unexpectedly, that it's too early to tell after two years of study if Connecticut's Health Enhancement Program has saved the state money.Their findings are reported in the April edition of Health Affairs. The Health Affairs article and related materials can be found below. Health Affairs Article IHPI Press Release HEP Infographic
This month's V-BID news update discusses recent support in the US House of Representatives, a new V-BID proposal from CMS, and a myriad of academic and news publications.
On Tuesday, March 8th, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would test a new way for Medicare Part B to pay for prescription drugs. The proposal includes value-based insurance design (V-BID) principles of discounting or eliminating cost-sharing and varying payments for drugs based on clinical effectiveness for different indicators (clinical nuance). CMS Acting Administrator Andy Slavitt stated, "These proposals would allow us to test different ways to help Medicare beneficiaries get the right medications and right care while supporting physicians in the process. This is consistent with our focus on testing value-based care models like we have been doing with physicians and hospitals in ACOs. Models like this one can help doctors and other clinicians do what they do best: choose the medicine and treatment that keeps their patients healthy." Read more on V-BID in the Medicare program.
