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 [...]
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.
New Cms Rule Provides More Flexibility for V-BID Benefitsin Medicare Advantage On April 16, 2018, CMS officially published their new rule for the Medicare program contract year 2019. This rule includes a reinterpretation of the Medicare Advantage (MA) uniformity requirement that will allow for more flexibility in benefit design for MA enrollees with specified chronic conditions. CMS determined: Providing access to services (or specific cost sharing) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the Medicare Advantage (MA) regulationsBeginning in 2020, CMS will wave the uniformity requirement for MA plans that provide additional supplemental benefits to chronically ill enrollees. This change paves the way for the further incorporation of V-BID principles into the Medicare Advantage program. While the ongoing MA V-BID Model Test will continue, plans outside of [...]
On April 18, 2018, The American Journal of Managed Care's Managed Care Cast interviewed Dr. A. Mark Fendrick in a segment called Examining Consumer Cost Sharing and a Precision Benefit Design With Dr Mark Fendrick. This podcast episode discussed a recently published paper, Cost Sharing and Branded Antidepressant Initiation Among Patients Treated With Generics, that examines the effects of increased cost sharing on the decision of patients with major depressive disorder (MDD) to fill prescriptions for second-line, branded antidepressants after already having tried first-line therapies. The finding that increased cost sharing for branded, second-line therapies was associated with a significant decrease in the likelihood of filling a prescription supports a dynamic, precision benefit design model in which cost sharing is lowered for higher-tier evidence-based therapies when clinically indicated. This proposed benefit design lowers consumer cost sharing for those who diligently follow the required steps for their condition, but who [...]
On March 28, 2018, the Morning Consult featured an op-ed written by V-BID Director, Dr. A. Mark Fendrick. The article, titled “The Health Care Spending Disconnect: Star Wars vs. Flintstones,” highlights the discrepancy between groundbreaking innovations in medical treatments and America's stone age care-delivery model. The disconnect between medical advancements available to patients and their ability to pay for them is addressed by the V-BID Center's Precision Benefit Design initiative, which recognizes that individualized therapies are often needed to achieve desired health outcomes. This proposed benefit design plan lowers consumer cost-sharing for patients who required a more costly targeted or alternative therapy for their condition. For the full article and more information on precision benefit design, click the buttons below.
2018 NDAA Supports Precision Benefit Design for Pharmaceuticals On Tuesday, December 12, 2017, the President signed the $700 billion National Defense Authorization Act for fiscal year 2018. The defense bill includes the incorporation of V-BID principles within Section 702 - Modifications of cost-sharing requirements for the TRICARE Pharmacy Benefits Program and treatment of certain pharmaceutical agents. Sec 702 (C) (b) (1) reads: This major policy milestone builds on growing bipartisan support and the expanded role of V-BID in public and private payers, including the recent expansion of the CMMI Medicare Advantage V-BID demonstration to 25 states and Congressional and Trump Administration efforts to allow high-deductible health plans the flexibility to provide coverage for services that manage chronic disease prior to meeting the plan deductible.View the resources below to learn more about V-BID in TRICARE and Precision Medicine. V-BID in TRICARE One-Pager TRICARE Infographic Precision Medicine Infographic Precision Medicine 1-Pager Precision Medicine White Board Video [...]
New Alexander-Murray bipartisan bill includes V-BID Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached an agreement on Tuesday, October 17th regarding their bipartisan bill to fund key insurance subsidies. The cost-sharing reduction payments reimburse insurance companies for lowering deductibles, co-payments and other out-of-pocket costs for low-income customers. Page 11 of the draft bill language includes a section on value-based insurance designs: "(iii) waivers encouraging or requiring health plans in such State to deploy value-based insurance designs which structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services;" Value-Based Insurance Design (V-BID) is a potential solution built on the principle of lowering or removing financial barriers to essential, high-value clinical services and providers. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services. These innovative programs are designed with the tenets of clinical nuance in [...]
On Wednesday, June 7th, Dr. A. Mark Fendrick, V-BID Center Director, testified before the Committee on Ways and Means, Subcommittee on Health hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries. Dr. Fendrick discussed how the principles of value-based insurance design (V-BID) and clinical nuance can contribute positively to Medicare Advantage. Learn more about V-BID in Medicare Advantage To view the full hearing, click here. Additional testimony materials available below: Learn more about V-BID in Medicare Advantage
Value-Based Insurance Design: An Innovative Approach to Improve Medicare Advantage, Health Savings Accounts, and TRICARE Washington, DC: On Tuesday, February 7, Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) convened a bipartisan briefing on the role of Value-Based Insurance Design (V-BID) in Health Savings Accounts, Medicare Advantage, and Tricare. V-BID Center Co-founders A. Mark Fendrick, MD, and Michael Chernew, PhD, discussed the role of V-BID as a bipartisan, multi-stakeholder solution to improve quality, enhance consumer experience, and lower costs. In their introductory remarks, Congressmen Black and Blumenauer highlighted the rare bipartisan support for V-BID and praised its role in improving the health of Americans and lowering health care spending. Both were enthusiastic about partnering on bipartisan legislation to expand V-BID in private and public payers. Access to quality medical care and containing health care expenditures are among the most pressing issues for our military personnel, our national well-being and economic security. Understanding how commercial [...]
