On January 18, 2019, the Center for Medicare and Medicaid’s (CMS) Innovation Center (CMMI) announced plans to expand their Medicare Advantage (MA) model, to allow health plans more flexibility to include hospice care and increase access to telehealth. Starting in 2020, the Value-Based Insurance Design model (VIBD)will allow more ways of delivering care to consumers, such as reducing cost-sharing, relying on telehealth, and providing more supplemental benefits to enrollees — including “non-primarily health-related” services such as transportation — based on a patient’s chronic condition or socioeconomic status. Further, in the 2021 plan year, plans in the model will be allowed to cover Medicare’s hospice benefit. CMS is also extending the performance period of the VBID model by an additional three years, through 2024.
The first round of VBID was launched in January 2017 to see if giving Medicare Advantage plans flexibility to offer certain supplemental benefits or reduce cost sharing would improve health outcomes and lower costs. The model is currently being used in 25 states, and under the new announcement, will be available to plans in all 50 states beginning in 2020.
For the CY 2020 VBID application period, which is open now through March 1, 2019, eligible Medicare Advantage organizations may apply to test one or more of the following new interventions:
- Participating MA plans may propose offering reduced cost-sharing or additional supplemental benefits, including for “non-primarily health related” items or services, for enrollees based on chronic condition, socioeconomic status determined by qualifying for the low-income subsidy and/or having dual-eligible status, or both. Plans may also propose allowing additional “non-primarily health related” supplemental benefits for all enrollees by disease state, regardless of socioeconomic status.
- MA and Part D plans may propose Rewards and Incentives programs with allowed values that “more closely reflect the expected benefit of the health-related service or activity, up to an annual limit,” to better promote improved health. Programs may be created for enrollees who participate in disease state management programs, engage in medication therapy managementwith pharmacists or providers, receive preventive health services, and actively engage in understanding their medications.
- MA plans may propose using telehealth services to meet network adequacy requirements, though organizations must ensure that enrollee choice is preserved and that enrollee access to an in-person visit, if that is the enrollee’s preference and choice, is maintained. CMS expects that this will provide MA plans with an opportunity to enter into underserved markets, including rural areas where there may be few to no MA plan choices.
Beginning in CY 2021, the VBID model will also test allowing Medicare Advantage plans to offer Medicare’s hospice benefit to increase access to hospice services and facilitate better coordination between patients’ hospice providers and other clinicians. CMS will release additional information and guidance on this intervention in the coming months through the VBID model website, and through open-door forum type events.
“Expanding choices for patients, aligning incentives, and providing new flexibility for insurers in Medicare Advantage and Medicare Part D will deliver better value from these programs,” said HHS Secretary Alex Azar. “The models being announced today create new incentives for plans, patients, and providers to choose drugs with lower list prices, and new ways to meet the unique healthcare needs of specific populations, prevent disease, and expand the use of telehealth. Today’s announcement draws on successes we have already seen in Medicare and advances our priority of using HHS programs to build a value-driven healthcare system.”
“The American healthcare system is very different today than it was thirteen years ago when the Medicare Advantage and Part D programs were launched in their current forms, but due to the slow pace of change in government, these programs have not been fully updated to reflect today’s realities,” said CMS Administrator Seema Verma. “Today’s announcements are prime examples of how CMMI can test policies to modernize CMS programs and ensure that our seniors can access the latest benefits. These two models ignite greater competition among plans, creating pressure to improve quality and lower costs in order to attract beneficiaries.”