Lowering health care expenditures and ensuring access to high quality medical care for Medicare beneficiaries is a health policy priority. Value-Based Insurance Design (V-BID) is an innovative approach to consumer cost-sharing that can improve quality of care and potentially lower costs in the Medicare Program. V-BID plans are designed with the tenants of clinical nuance, recognizing that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where and by whom the service is provided. The most significant opportunity for V-BID implementation lies in the Medicare Advantage (MA) program.
There are two options for incorporating V-BID principles in MA:
- the MA V-BID Model Test
- increased plan flexibility allowed by the reinterpretation of the uniformity rule
MA V-BID Model Test
In January 2019, The Centers for Medicare and Medicaid Services (CMS) announced transformative updates to the MA V-BID model. For the CY 2020 VBID application period, eligible Medicare Advantage health plans in all 50 states and territories were able to apply to test one or more of the following interventions:
- Value-Based Insurance Design by Condition, Socioeconomic status, or both;
- Medicare Advantage and Part D Rewards and Incentives Programs;
- Telehealth Networks; and
- Wellness and Health Care Planning (required for V-BID model participants)
The MA V-BID model is extended through 2024 and will test a carve-in of Medicare’s hospice benefit in MA in 2021. Special Needs Plans and Regional PPOs in all states and territories were eligible to apply for the model. The MA V-BID model test aims to assess the utility of structuring consumer cost-sharing and plan elements to encourage the use of high-value clinical services and providers for beneficiaries with chronic conditions. V-BID approaches have increasingly been used in the commercial market, and the inclusion of clinically nuanced V-BID elements may be an effective tool to improve the quality of care and reduce the cost of care for Medicare Advantage enrollees with chronic diseases and certain socioeconomic characteristics (i.e., low income status, including dual eligibles)1.
Increased Plan Flexibility
Moreover, in April 2018, the Centers for Medicare and Medicaid Services (CMS) reinterpreted the Medicare Advantage uniformity requirement. Beginning in 2019, this reinterpretation allowed MA plans outside of the V-BID model to offer their beneficiaries V-BID benefit designs for Medicare Part C without being subject to the additional application and geographic limitations of the current model.
|Bringing both the “vision” and “real world experience” into a single conversation, this workshop is designed to arm Medicare Advantage and Special Needs Plans with the insights needed to better evaluate the unique opportunities that MA V-BID Model presents for their health plan.|
Director of Medicare, UPMC Health Plan
MA V-BID Model Lead, CMMI
Director, UM V-BID Center
Counsel, Manatt, Phelps & Phillips
Medicare Advantage Program Manager, SelectHealth
Program Manager, Logistics Management Institute
VP of Product Mgmt & Market Intelligence, Health Alliance Plan