CMS to expand Medicare Advantage value-based insurance design model


The Medicare Advantage Value-Based Insurance Design model is set to expand to three new states in 2018, according to the Centers for Medicare & Medicaid Services.

In the program's second year, Alabama, Michigan and Texas will join the VBID model. The model will go through its pilot rollout in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee starting in 2017. Participating plans in will be announced this September.

The states were selected on a basis of how well they represent the national Medicare Advantage market, according the report. This included looking at places with varying levels of Medicare expenditures, low-income subsidies and supplier competition within the MA market.

Featured Webinar

Reducing barriers to patient care: A cross-industry collaboration

Optum will bring together cross-industry experts to share a case study detailing how an employer, provider, payer and pharmaceutical company worked together to address migraines, a hard-to-diagnose condition. Learn how this team started with a model to risk stratify, predict undiagnosed, misdiagnosed and mismanaged members and how those analytics were used to enrich engagement for treatment and diagnosis optimization.

VBID plans will offer supplemental benefits for enrollees with chronic conditions such as heart disease, diabetes, hypertension and mood disorders, a component of CMS’ goal to shift toward value-based payment models. As part of the 2018 expansion, beneficiaries with rheumatoid arthritis and dementia will now be eligible for what CMS calls "clinically nuanced benefit packages."

A VBID model tested in Connecticut was effective at increasing the use of preventive healthcare services among participants, FierceHealthPayer has reported.

The industry is increasingly embracing vale-based care. In fact, providers, payers and patients are on course to place 75 percent of members in value-based care arrangements by 2020, according to a healthcare task force.

- read the CMS announcement

Suggested Articles

A New Jersey medical office has filed suit against Cigna, alleging that the insurer failed to pay for diagnostic testing and treatment for COVID-19.

CMS issued new guidance Friday to help states implement the new interoperability policies in Medicaid and CHIP programs.

GoodRx has released its latest list of the most expensive drugs in America, with orphan drugs and therapies for rare conditions topping the ranking.