Senators John Thune (R-SD) and Tom Carper (D-DE), introduced the Chronic Disease Management Act of 2019 in the Senate (S. 1948), followed by the introduction of the companion bill in the House of Representatives (H.R. 3709) by Representatives Earl Blumenauer (D-OR) and Tom Reed (R-NY).
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives from mid-February to early July 2019.
On June 24, 2019, President Trump signed an executive order, and Senators John Thune (R-S.D.) and Ben Carper (D-DE) introduced bipartisan legislation that allow health savings account eligible high-deductible health plans (HSA-HDHPs) the flexibility to cover essential medications and services used to treat chronic diseases prior to meeting the plan deductible.
On Tuesday, May 7, 2019, Dr. A. Mark Fendrick, MD, Director of the Center for Value-Based Insurance Design (V-BID), spoke at the HealthCare 21 Business Coalition’s annual forum in Knoxville, TN.
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives from the end of 2018 through mid-February 2019.
February 25, 2019 – The Morning Consult has published an opinion-editorial co-authored by V-BID Center Director, Dr. A Mark Fendrick, and President & CEO of the PAN Foundation, Dan Klein.
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives from the end of 2018 through mid-February 2019.
The Drug Price Iceberg: More Than Meets the Eye When it comes to the political iceberg of drug prices, there is more than meets the eye. Policies that reduce prices but do not lower consumers’ out-of-pocket costs will not address the main challenge facing most Americans. Access to affordable prescription drugs is a topic of increasing public concern. In a recent survey, 82% of respondents identified medical costs as their biggest financial challenge. Although prescription spending growth has moderated and drug spending remains a relatively small part of total medical expenditures, a 2018 Kaiser Family Foundation poll showed that a significant majority of Americans think that Congress and the president are not doing enough about the problem. The fact that a majority of American adults use prescription medications is likely driving the issue of drug affordability as a policy priority. Nearly 3 in 5 American adults take [...]
Introducing V-BID 2.0: CMS Announces Updates to Medicare Advantage V-BID Demo January 18, 2019 - The Centers for Medicare and Medicaid Services (CMS) announced transformative updates to the Medicare Advantage Value-Based Insurance Design (MA V-BID) model. These changes aim to increase choice, lower cost, and improve the quality of care for Medicare beneficiaries. The model launched on January 1, 2017, and has since been expanded to include 25 states, 9 chronic conditions, Chronic Condition Special Needs Plans, and allows participants to propose their own systems or methods for identifying eligible enrollees. Riding on the heels of the Bipartisan Budget Act of 2018, which included a directive to expand the model to all 50 states by 2020, today's release makes sweeping changes to the CY2020 model, including: Allows plans to provide reduced cost-sharing and additional benefits to enrollees in a more targeted fashion Bolsters rewards and incentives programs that plans can offer beneficiaries to [...]
White House Report Urges Broader Coverage for Chronic Diseases in HSA-Qualified High-Deductible Health Plans On December 3rd, 2018, the White House released its 119-page report, Reforming America's Healthcare System Through Choice and Competition. In this report, HHS, in collaboration with the Department of Treasury, Labor, the FTC, and the White House, sets forth many formal recommendations aimed toward developing a better health care system. The report highlights the need for HSA reform and, more specifically, advocates for the expansion of the scope of preventive care and chronic condition services covered before the minimum deductible is met. An excerpt from pages 82 and 83 is included below: "As noted above, an additional constraint on the availability and use of HSAs is the requirement that HSA-qualified plans can only provide certain preventive care benefits before the minimum deductible is met. Reconsideration of the scope of [...]
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
The American Medical Association Council on Medical Service and Council on Science and Public Health recently released a joint report that strongly endorsed value-based insurance design as a potential solution to align clinical and financial incentives for high-value care. The report listed eleven key policy recommendations, including the following: Support clinically nuanced V-BID plans Support the requirement of private health plans to provide coverage for evidence-based preventive services without cost-sharing for patients Support Medicare Advantage V-BID plans Support legislative and regulatory flexibility to implement V-BID, including expanding the safe harbor of HSA-eligible high-deductible health plans to include coverage for preventive care and chronic diseases Encourage national medical specialty societies to identify high-value services and collaborate with payers to experiment with plan designs that align incentives with utilization of high-value services The AMA House of Delegates adopted all report recommendations. To read the full report and AMA News [...]
A Patient-Centered Approach to Medicare Drug Reform Dr. A Mark Fendrick, V-BID Center Director The Trump administration has recently proposed a number of sweeping changes to the Medicare program to curb taxpayer spending on prescription drugs. These include price setting, revamping how doctors and hospitals acquire drugs, and changing how physicians are reimbursed for medicines. The changes apply to “Part B,” the component of Medicare that covers medicines administered in a health-care facility, like gene therapies and advanced treatments for cancer, arthritis, and multiple sclerosis. Today, physicians purchase these medications directly. Each of the suggested reforms are blunt instruments that focus exclusively on drug prices without fully accounting for clinical value. These changes may reduce short-term expenditures, but will likely restrict access to the lifesaving medications that many seniors rely on. These policies also miss the critical clinical point that in certain patient [...]
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
Basing patients' medication costs on the health benefits they'll get from a drug, rather than its price, means they're more likely to take it Excerpt from IHPI press release:"Taking a medicine every day in the hopes that it will prevent some long-range potential health catastrophe -- like a heart attack or kidney failure -- isn’t easy.Many people skip doses, or don’t refill their prescriptions on time, or at all. And plenty of studies have shown that the more patients have to pay for those prescriptions, the less likely they are to take them as directed.But new evidence shows the power of a method aimed at changing this behavior: insurance plans that charge patients less for the medicines that could help them most. Some plans even make some of the medicines free to the patients with certain conditions.In an article published in the July issue of Health [...]
