Value-based insurance trial to test benefit of custom plans for chronic conditions

A new Medicare Advantage pilot program that allows insurers to custom-design coverage plans to emphasize value-based care launches on January 1, 2017.

Under the Medicare Advantage Value-Based Insurance Design (VBID) Model, Medicare Advantage plans can offer supplemental benefits or reduced cost sharing to enrollees with specified chronic conditions.

The Centers for Medicare & Medicaid Services (CMS) said the model, part of the Health Plan Innovation Initiatives, “will test whether this can improve health outcomes and lower expenditures for Medicare Advantage enrollees.”

Slated to run for five years, the VBID model in 2017 will be tested in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Three more states -- Alabama, Michigan and Texas – will take part in the test starting in 2018.

Upon approval from CMS, eligible Medicare Advantage plans next year can offer varied plan benefit design for enrollees with the following clinical conditions (as identified and defined by CMS): diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of these categories. CMS will allow benefits for enrollees with dementia and rheumatoid arthritis beginning in 2018.

CMS said that while changes to benefit design under the VBID model may reduce cost-sharing and/or offer additional services to targeted enrollees, “targeted enrollees can never receive fewer benefits or have to pay higher cost-sharing than other enrollees as a result of the model.”

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Nine insurers are participating in the VBID pilot program, including Aetna, Blue Cross Blue Shield, Fallon Community Health Plan, Geisinger Health Plan, Highmark, Independence Blue Cross, Indiana University Health Plan, Tufts Associated Health Plan, and UPMC Health Plan.

Specifics of the insurers’ plans won’t be known for at least two months because CMS won’t allow insurers to divulge details during Medicare 2017 open enrollment, which runs from October 15 to December 7, 2016.

But as Healthcare Finance News Associate Editor Susan Morse writes, “Under value-based insurance design, for example, an insurer can waive the $20 copay for a diabetic patient to get an eye exam. Eyes can become damaged by diabetes, and getting care early for a condition revealed by an eye exam could prevent 

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