10-Year CMMI Strategy to Address Affordability Includes
Value-Based Insurance Design
October 20, 2021– the Centers for Medicare and Medicaid Services Innovation Center (CMMI) has released a white paper detailing its strategic direction for the next decade. The paper, “Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade”, discusses five objectives that will guide its efforts to achieve equity through high quality, affordable, person-centered care.
Value-Based Insurance Design (V-BID) is included under objective four, “Improve Access by Addressing Affordability”, as a method to address health care prices, affordability, and reduce unnecessary care:
Under VBID, health plans modify the incentives that they offer to enrollees to encourage high-value care. The Innovation Center is testing VBID in the Medicare Advantage program, allowing plans flexibility to provide supplemental benefits for beneficiaries based on health conditions and/or socioeconomic factors. These benefits include reduced cost-sharing for high value care, access to new and existing technologies and FDA-approved medical devices, vouchers for transportation to health care visits and for over-the-counter medications recommended by their providers, as well as items and services that have a reasonable expectation of improving or maintaining the health or overall function of an enrollee with regard to the chronic condition or socioeconomic status, which may include food and housing supports. The model also requires plans to engage with their enrollees in wellness and advance care planning, and some plans are also testing access to concurrent hospice care. Lessons learned from these efforts could be tested more broadly to increase utilization of high-value care in future CMS Innovation Center efforts.
Implementation of V-BID programs which reduce consumer cost-sharing for high-value services and providers for select chronic conditions is a viable and fiscally feasible option for the Medicare program. Moreover, the alignment of consumer engagement initiatives with ongoing provider-facing, value-based payment initiatives is a critical step to improve quality of care, enhance patient experience, and contain cost growth.