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V-BID Summit

How Public Payers Are Adopting VBID Principles Despite Constraints

Christina Mattina
During a session on expanding the role of value-based insurance design (VBID) in public insurance at the University of Michigan V-BID Center’s annual V-BID Summit on March 14, panelists representing 3 different payers shared how they have seen value-based principles take hold in their plans and their predictions for the future.
According to Finkelstein, CMS hasn’t collected many data since the limited test model was rolled out in 10 MA parent organizations in 2017, but no news may be good news: the agency has not heard any public complaints from participants. Although not many plans have rushed to apply yet, Congress has mandated that the model be conducted in all 50 states by 2020.

“Both Congress and the administration have given plans a lot of new flexibility … so there’s a bigger palette for plans to paint with in terms of benefits,” Finkelstein explained.

In response to an audience question about communicating the “carrots and sticks” of VBID, the panelists described strategies that differed based on which group or entity needs to buy into the changes. Simmer explained that TRICARE has convinced Congress to adopt VBID principles in the program by partnering with the constituents and advocacy groups that policy makers tend to listen to.

Levitt recounted her experiences negotiating with the municipal labor committee by tying wage increases to the unions’ willingness to participate in the health cost savings experiment. Union leadership had to be on board with the idea and then sell it to the employees, she said. The plan is on track to save more than $3.4 billion by the end of the 4-year period in July, so the unions will receive any extra savings above that benchmark.

Next, Goodman asked the panelists to share their practical expectations about the viability of VBID expanding to all 50 states. Finkelstein anticipated that we will see plans “start to get braver” about adopting VBID; specifically, the private sector may respond well to being able to choose a standardized VBID plan “off the shelf.”

Levitt agreed that the movement focusing on VBID and population health will have to grow nationally in order for plans to push back against rising costs while still benefiting the patient population. She also noted that these efforts in the city’s health plan moved more slowly than she had hoped, but they have still accomplished a number of positive changes.

Simmer said that the next area of focus for TRICARE will be to involve the beneficiaries by asking what value means to them. He also talked about the need for greater flexibility, which can be difficult in TRICARE, which has a 5000-page manual governing how the program provides healthcare.

“How do we work that 5000-book to allow that flexibility so that each patient and provider can find the right solution for them?” he asked.

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