Medicare Advantage VBID Model to Cover More States, Add Dementia and Rheumatoid Arthritis


Adding more states and conditions to the Medicare Advantage value-based insurance design model will allow CMS to reach a more diverse group of plans and patients, in both rural and urban settings.

More states and 2 new conditions will be added to a value-based insurance design (VBID) model for Medicare Advantage, CMS announced Wednesday.

Alabama, Texas, and Michigan will join the states currently testing the model in a host of chronic conditions, including diabetes, hypertension, and recovery from stroke. Mood disorders were also included. Two new conditions--rheumatoid arthritis and dementia--will be added starting in January 2018.

The change gives CMS another tool to meet its goal of making 50% of Medicare payments through alternate payment models by 2018. The goal of 30% for 2016 was passed earlier this year.

The first round of the Medicare Advantage VBID model starts in January 2017 and will affect 7 states: Arizona, Iowa, Pennsylvania, Indiana, Oregon, Massachusetts, and Tennessee. MA plans have already applied for that round, and CMS will announce the plans approved for participation next month, according to a statement. Plans approved for that round will operate the model for 5 years.

Opening the model to new conditions and 3 more states, as well as changing the minimum enrollment size, will allow a more diverse group of plans to participate, according to CMS. Federal health officials seek to test the MA-VBID models in a variety of settings, both rural and urban.

Value-based insurance designs seek to encourage high-value clinical services and behavior by making it easier for beneficiaries to gain access to those services that offer the best health outcomes for the best price. Current Medicare Advantage plans have “uniformity” requirements that don’t allow plans to offer differ cost-sharing options to different enrollees. The VBID models being studied allow plans offer “clinically nuanced” cost-sharing tailored to meet patients specific health conditions, with the goal of providing higher quality, more cost-effective care.

According to CMS, the VBID models will be specifically designed to incorporate prescription drug benefits under Medicare Part D.

The announcement states that the VBID models can use 4 different approaches: (1) reduce cost-sharing for high-value services, (2) reduce cost-sharing when using high-value providers, (3) reduce cost-sharing for enrollees who take part in disease management programs, and (4) coverage of additional supplemental benefits.

In diabetes care, for example, VBID models can be used to encourage enrollees with the disease to see a case manager or to use digital technologies.

To participate, MA plans must have quality ratings of 3 stars or higher.


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