Health Affairs Blog: Expanding the Definition of Prevention Promotes Health Care Value
For Immediate Release March 12, 2015, Ann Arbor, MI. Embracing prevention is a widely accepted part of the health care transition from volume to value. The Patient Protection and Affordable Care Act (ACA) mandates the elimination of consumer cost-sharing for selected preventive services in commercial health plans. In this context, prevention is defined to include services provided to asymptomatic individuals, such as screenings, immunization and counseling. A new Health Affairs blog post examines how the prevailing focus on primary prevention tilts the system away from clinical services often of much greater value - those that manage and prevent adverse consequences associated with chronic disease. In Medicare and Health Savings Account-eligible High-Deductible Health Plans (HSA-HDHP), the narrow definition of preventive services precludes expanded access to many proven high-value clinical services, many of which are quality metrics used by value-based purchasing initiatives. Authors Michael Chernew, Sandy Schwartz, and Mark Fendrick [...]
New V-BID videos showcase a decade advancing the health care cost discussion
V-BID's updated member profile and policy brief describe the Center's history, current private/public sector implementation measures, and future directions as a member of the University of Michigan's Institute for Healthcare Policy and Innovation.
Low premiums yet big bills – why high-deductible health plans need reform
Low premiums yet big bills – why high-deductible health plans need reformThis article was originally published on The Conversation.By Betsy Q Cliff, University of Michigan and A. Mark Fendrick, University of MichiganA few years ago, we met Angie, a hair salon owner in Oregon with health insurance coverage and a stack of unpaid medical bills. She and her husband were both employed – he as a carpenter — and earned about US$45,000 a year, a bit less than the median income in their county. They were raising two children. Their health insurance had a deductible of US$4,000 for each person, capped at US$8,000 for the family, which meant they had to pay that much before benefits would kick in.Angie said she had been putting off needed medications for a chronic endocrine disorder and other medical care because they couldn’t afford to pay more on top of the [...]
Growing momentum for V-BID in Medicare Advantage plans
Responding to growing momentum for clinical nuance in Medicare Advantage, the V-BID Center has provided substantial comments on the recent CMS RFI regarding a V-BID demonstration project in Medicare Advantage (MA) and Medicare Advantage prescription drug plans (MA-PD). These comments contain explicit, evidence-based recommendations to address some of Medicare’s most complex challenges regarding effective benefit design features, cost-sharing parameters, consumer/provider engagement methods, quality measures, actuarial value considerations, among other topics, while also exploring potential barriers to implementation. This RFI capitalizes on ongoing interest in V-BID at the federal/legislative level. Earlier this September, US Senators John Thune (R-SD) and Debbie Stabenow (D-MI) introduced legislation S.2783: The V-BID for Better Care Act of 2014. The bipartisan, bicameral bill directs the Secretary of Health and Human Services to establish a three-year demonstration program allowing participating MA plans to test V-BID principles of reduced copayments and coinsurance for high-performing providers, evidence-based [...]
V-BID submits comments to CMS RFI on Medicare Advantage
In response to the recent CMS RFI regarding implementing V-BID in MA, MA-PD plans, the V-BID Center has submitted comments substantively exploring this option. We hope that you will share this document with interested parties. Please feel free to comment on this document or contact us if you would like additional information.
Fendrick Elected to Institute of Medicine
Monday, October 20, 2014. Washington, DC. Today, the Institute of Medicine (IOM) announced that V-BID Center Director, A. Mark Fendrick, MD, has been elected to join its membership. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Established in 1970 by the National Academy of Sciences, IOM has become recognized as a national resource for independent, scientifically informed analysis and recommendations on health issues. For additional details, read the official University of Michigan Health System press release.
V-BID Director on ‘Understanding Healthcare with Paula Zahn’
V-BID Center Director, Dr. A. Mark Fendrick was recently a featured guest on “Understanding Healthcare with Paula Zahn.” Both the preview and full-length episode are available online.
Seizing Opportunity to Provide Clinical Nuance in Medicare Advantage
Medicare provides health insurance to 54 million elderly and disabled Americans. Enrollment is expected to increase rapidly in coming years, as 10,000 baby boomers becoming eligible for Medicare each day. However, without action, the costs of Medicare—both per enrollee and growth in spending—threaten the program’s solvency. While predictions are less dire than previously expected, there is still much work to be done to align spending, quality, and care. Currently, enrollees in Medicare fee-for-service (FFS) face a “one-size-fits-all” approach to cost sharing. However, Medicare Advantage (MA) plans offer a unique opportunity to break out of the current mold of fee-for-service delivery and payment. As outlined in a V-BID brief on Medicare Advantage, private health plans have flexibility to use care management techniques to promote evidence-based, high value network formation, high performing provider-facing interventions (e.g., bonuses for quality and high performance), and utilization management programs to identify under-utilization as [...]