- CMS has announced the Medicare Advantage Value-Based Insurance Design Model program.
- The model will test whether giving Medicare Advantage plans flexibility to offer targeted supplemental benefits or reduced cost sharing to enrollees with chronic conditions can lead to cost-efficient care.
- It focuses on Medicare Advantage enrollees with the chronic conditions of diabetes, congestive heart failure, chronic obstructive pulmonary disease, past stroke, hypertension, coronary artery disease, mood disorders, and combinations of these categories.
The model will begin January 1, 2017 and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.
“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 Dr. Patrick Conway, CMS deputy administrator and chief medical officer.
In a blog post, Conway wrote, “Plans have the flexibility to choose amongst the eligible categories, and design separate interventions for each one. Changes to benefit design made through this model may only reduce cost sharing for services, and/or offer additional services; enrollees will never receive fewer benefits or have to pay higher cost sharing as a result of the model.”