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CMS NEWS
FOR IMMEDIATE RELEASE
September 1,
2015
Contact: CMS Media Relations
CMS
announces Value-Based Insurance Design Model
to
improve care and reduce costs in Medicare Advantage Plans
The Centers for Medicare & Medicaid Services (CMS) announced today
the Medicare Advantage Value-Based Insurance Design Model, which will test
the hypothesis that giving Medicare Advantage plans flexibility to offer
targeted extra supplemental benefits or reduced cost sharing to enrollees
who have specified chronic conditions can lead to higher-quality and more
cost-efficient care, helping health plans and consumers have the tools they
need to improve costs and spend dollars more wisely.
The goal of the model is to improve beneficiary health, reduce the
utilization of avoidable high-cost care, and reduce costs for plans,
beneficiaries and the Medicare program. The model focuses on Medicare
Advantage enrollees with the chronic conditions of diabetes, congestive
heart failure, chronic obstructive pulmonary disease (COPD), past stroke,
hypertension, coronary artery disease, mood disorders, and combinations of
these categories.
“The Medicare Advantage Value-Based Insurance Design Model fills an
immediate need for testing ways to improve care and reduce cost in Medicare
Advantage Plans and offers the prospect of lower out-of-pocket costs and
premiums along with better benefits for enrollees in Medicare Advantage,”
said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical
officer.
Part of the Department of Health and Human Services’ (HHS) “better
care, smarter spending, healthier people” approach to improving health care
delivery, the model is intended to improve outcomes and reduce costs by
giving health plans the flexibility to provide new supplemental benefits
specifically tailored to the enrollees’ clinical needs, such as the elimination
of co-pays for eye exams for beneficiaries with diabetes or extra tobacco
cessation assistance for enrollees with COPD. The model will begin
January 1, 2017 and run for five years in Arizona, Indiana, Iowa,
Massachusetts, Oregon, Pennsylvania, and Tennessee.
Value-Based Insurance Design (VBID) generally refers to health
insurers’ efforts to structure enrollee cost-sharing and other health plan
design elements to encourage enrollees to use high-value clinical services
– those that have the greatest potential to positively impact enrollee
health. VBID approaches are increasingly used in the commercial market, and
evidence suggests that the inclusion of clinically-nuanced VBID elements in
health insurance benefit design may be an effective tool to improve the
quality of care and reduce the cost of care for Medicare Advantage
enrollees with chronic diseases.
The Medicare Advantage Value-Based Insurance Design Model was
developed by the Center for Medicare and Medicaid Innovation (Innovation
Center). The Innovation Center was created by the Affordable Care Act to
test innovative health care payment and service delivery models that have
the potential to reduce Medicare, Medicaid, and Children’s Health Insurance
Program expenditures while preserving or enhancing the quality of
beneficiaries’ care.
More information about the
MA-VBID model test can be found in the model’s announcement. It includes
instructions for providing CMS with feedback on this model test’s design.
CMS will also hold a webinar introducing the model on September 24, 2015.
The announcement and webinar registration information are both available at
http://innovation.cms.gov/initiatives/VBID/.
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