V-BID in Medicare Advantage
Ensuring Access to High Quality Medical Care
Medicare Advantage plans are playing an increasingly larger role in the Medicare program as the portion of Medicare beneficiaries who are enrolled in MA have increased to 33% in 2017 and is projected to reach 41% in 2027. However, out-of-pocket costs for MA beneficiaries continue to rise and enrollees are faced with higher cost sharing, often resulting in patients forgoing essential medical care due to financial barriers. There is robust support to suggest that this decreased use of evidence-based services leads to reductions in care quality, sub-optimal patient outcomes, and, in certain instances, increases in overall health care spending.
V-BID in MA
Incorporation of V-BID principles into MA Plans has garnered multi-stakeholder and bipartisan political support. V-BID can encourage the utilization of high-value providers and services and limit the use of services that are of potentially low-value, thus helping MA plans improve health and quality, enhance consumer engagement, and reduce healthcare costs.
MA V-BID Model Test
As the debate over rising healthcare expenditures continue to evolve, policymakers have begun to explore consumer engagement initiatives, in addition to provider payment reforms, as a possible solution to curbing rising costs. One way policymakers are making this change is through the Centers for Medicare and Medicaid Services’ MA V-BID Model Test.
Launched in January 2017, the five-year demo model permitted nine MA plans across Massachusetts, Indiana, and Pennsylvania to vary benefit designs for enrollees with specified clinical conditions (diabetes mellitus (DM), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, and mood disorders). Actuarial modeling of MA V-BID programs for DM, COPD, CHF demonstrates that consumer out-of-pocket costs are reduced in all 3 conditions, plan costs increase slightly in the short term for certain conditions (DM and COPD), and plan savings result for CHF. From societal perspective, net savings resulted in the COPD and CHF programs while the DM program was close to cost neutral.
In June 2017, Dr. Fendrick testified before the House Ways and Means Subcommittee on Health during their Medicare Advantage Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries. There, Dr. Fendrick advocated for the passing of the CHRONIC Care Act of 2017, a bipartisan bill that specifically calls for the expansion of the MA V-BID demonstration to all 50 states. Expansion of the MA V-BID demo will improve the quality of MA plans and the health of Medicare beneficiaries.