March 2016 News Update
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.
NEWS UPDATE: CMS Proposed Rule for Part B Drugs includes V-BID Principles
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.
February 2016 News Update
The February 2016 V-BID news update highlights V-BID in action in defense health care reform, Michigan Medicaid, and Medicare Advantage. The news update also features recent research and popular press publications, and three newly developed V-BID infographics.
AJMC: Geisinger V-BID Program
Dr. Mark Fendrick discusses how the Geisinger V-BID Program leads to savings by eliminating drug co-payments A study published in the February 2016 issue of The American Journal of Managed Care investigated the potential cost-savings of a $0 prescription co-pay program for chronically ill employees of the Geisinger Health System (GHS). Approximately 200 anti-hypertensive, anti-diabetic, and anti-lipid medications were provided at zero cost-sharing to 2251 GHS employees as part of an employee health and wellness program. The program showed positive cost-savings and a positive 5-year return on investment.
February 23, 2016: US Senate Committee on Armed Services
On Tuesday, February 23rd, Dr. A. Mark Fendrick, V-BID Center Director, testified before the United States Senate Committee on Armed Services Subcommittee on Personnel. Dr. Fendrick discussed how the principles of value-based insurance design (V-BID) and clinical nuance can contribute positively to defense health care reform.https://youtu.be/zprEwpVgXCo Additional testimony materials available below:
January 2016 News Update
This month's news update explores the role for V-BID in mental health disorders, cost-related non-adherence, and how higher out-of-pocket costs are driving E-visits.
V-BID Whiteboard Video: Goldilocks Chooses A Health Plan
Choosing a Health Plan? Check out our new Whiteboard Video! The University of Michigan Center for Value-Based Insurance Design (V-BID) is pleased to introduce our very first student-created whiteboard video, Goldilocks Chooses a Health Plan. Much like finding the right bed, choosing a health plan can be challenging. Watch as Goldilocks traverses through the complicated health insurance market of 'too soft' and 'too hard' health plans, and then discovers the Value-Based Insurance Design Plan, which is 'just right.' With this 'just right' health plan, Goldilocks has financial incentives to utilize high-value services and skip services of unproven value. This plan also lowers cost-related non-adherence, improved health outcomes, and avoids the Cadillac Tax. For more information on choosing a 'just right' health plan, please contact the V-BID Center at vbidcenter@umich.edu.
CMS Announces Medicare Advantage V-BID Model Test
News Update: CMS Announces Medicare Advantage V-BID Model Test On September 1, 2015, the Centers for Medicare and Medicaid Services (CMS) announced a program to test Value-Based Insurance Design (V-BID) in Medicare Advantage (MA) plans. The program will examine the utility of structuring patient cost-sharing and other health plan design elements to encourage patients to consume high-value clinical services, thereby improving quality and reducing costs. The model test is scheduled to begin on January 1, 2017. CMS will conduct the model test in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. "The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage," said Patrick Conway, MD, MSc, CMS deputy administrator and chief medical officer. For additional information about the CMMI [...]
NEWS UPDATE: V-BID Medicare Advantage Bill Passes House of Representatives
Washington, DC – The Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 (HR 2570) was passed by the US House of Representatives on June 17th. This bipartisan legislation includes a V-BID demonstration project that would allow Medicare Advantage plans to lower copayments and coinsurance for their beneficiaries, encouraging the use of high-value, evidence-based medical services to better manage chronic conditions. The legislation explicitly prevents plans from increasing beneficiary cost-sharing on any service. A bipartisan companion bill, Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 (S.1396), was introduced to the Senate on May 20th. This legislation coincides with a CMS Request for Information to Innovate Medicare that explicitly included V-BID.
UPDATE: MA V-BID Bill Passes Key House Committee
WASHINGTON, D.C. – The Preservation of Access for Seniors in Medicare Advantage Act of 2015 (HR 2581) was passed by the Ways and Means Committee on June 2nd. This legislation would require the Secretary of Health and Human Services to select MA plans to begin testing V-BID methodology. This demonstration project would allow plans to lower copayments and coinsurance for their beneficiaries, encouraging the use of high-value, evidence based medical services to better manage chronic conditions. The legislation explicitly prevents plans from increasing beneficiary cost-sharing on any service. This bipartisan legislation will be discussed on the floor of the House of Representatives as part of a package of bills aimed to strengthen the Medicare Advantage program. A bipartisan companion bill, Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 (S.1396), was introduced to the Senate on May 20th.
BREAKING NEWS: Thune-Stabenow Bill to Establish V-BID Demonstration in Medicare Advantage
WASHINGTON, D.C. – U.S. Sens. John Thune (R-S.D.) and Debbie Stabenow (D-Mich.) today reintroduced bipartisan legislation that would establish a Medicare Advantage (MA) demonstration program to evaluate how value-based insurance design (V-BID) could reduce MA enrollees’ copayments and coinsurance for some beneficiaries with specific chronic conditions for certain high-value medications and services resulting in better health outcomes and reduced overall health spending. “We recognize that it’s a challenge to find policy solutions that achieve cost savings while at the same time improving patients’ health outcomes,” said Thune. “With V-BID, a promising health insurance concept, both patients and taxpayers win, proving that if money can be spent in a more targeted, effective way, it’s also possible to improve the value of care delivered.” “This legislation is a win-win,” said Stabenow. “It tests a new innovative model that lowers costs to Medicare patients for prescription drugs and services that provide [...]
Beyond SGR: Aligning Payment Reform with Consumer Engagement
Health Affairs Blog Post: "Beyond SGR: Aligning The Peanut Butter Of Payment Reform With The Jelly Of Consumer Engagement" Building on the bipartisan repeal of Medicare's sustainable growth rate physician reimbursement model, this Health Affairs blog post explores how this value-driven movement provides a critical opportunity to combine both provider-facing initiatives, or "peanut butter" with consumer-driven strategies, aka "jelly" to produce innovative strategies that promote better consumer access to services on which their clinicians are benchmarked and financially rewarded for providing. The blog also urges value-based insurance design-inspired PB & J efforts to address regulatory barriers in HSA-eligible High Deductible Health Plans to allow voluntary flexibility to cover a broader spectrum of high-value services tied to quality metrics on a pre-deductible basis and to permit variation in beneficiary cost-sharing for guideline-recommended services for selected chronic conditions in specific populations enrolled in Medicare Advantage plans. The Center for Value Based [...]