Dive Brief:
- CMS' Center for Medicare and Medicaid Innovation has announced some updates that will take effect in the second year of the Medicare Advantage (MA) Value-Based Insurance Design (MA-VBID) model, which is set to allow MA plans to offer targeted benefit packages or reduced cost sharing to enrollees with certain chronic conditions to strive for cost efficiency.
- Initial details for the first year of the model, slated to begin Jan. 1, 2017, were released last September.
- It has now been added in the second year of the model, beginning Jan. 1, 2018, CMS will open the model test to new applicants, add three new states, and add two additional conditions, among other changes.
Dive Insight:
The model, which begins Jan. 1, 2017, will run for five years, initially beginning in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee. The announcement states the second year will add Alabama, Michigan, and Texas.
The first year will focus on enrollees with with diabetes, congestive heart failure, chronic obstructive pulmonary disease, past stroke, hypertension, coronary artery disease, and mood disorders. The second year will add rheumatoid arthritis and dementia to the list.
In addition during the second year, the program will adjust its existing clinical categories and adjust the minimum enrollment size for some MA and MA-Part D plan participants, CMS stated.
Through the test CMS will evaluate whether the incorporated health plan design elements impact enrollee behavior toward more effective and lower-cost use of healthcare services.
"VBID approaches are increasingly used in the commercial market," the CMS noted, "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 while reducing its cost for Medicare Advantage enrollees with chronic diseases."