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.
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.
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:
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.
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.
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 [...]
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.
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.
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 [...]
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 [...]
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 [...]
