VBID Model Could Boost Quality Metrics for MA Plans, Industry Observers Tell AIS Newsletter

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The October 2015 issue of Atlantic Information Services’ AIS’s Value-Based Care News takes a look at CMS’s new Value-Based Insurance Design Model to treat Medicare Advantage enrollees with certain chronic conditions.

Medicare Advantage (MA) plans in certain states will have the flexibility to offer targeted extra benefits or reduced cost-sharing to enrollees with specific chronic conditions under the Centers for Medicare & Medicaid Services’ (CMS) new Value-Based Insurance Design (VBID) Model, unveiled early last month. The October 2015 issue of AIS’s Value-Based Care News (VBC), published by Atlantic Information Services, Inc., takes a look at VBID, with one industry observer telling the newsletter that although MA plans won’t get extra money from CMS, plans using the model could see other benefits.

Plans could improve health outcomes for enrollees, perhaps improving their quality metrics at the same time, Helaine Fingold, an attorney with Epstein Becker Green in Baltimore, tells VBC. “To the extent that a plan’s VBID project does in fact improve financial outcomes, this might allow the plan to use any savings achieved to offer a more attractive benefit package,” she says. “VBID has the potential to help plan sponsors achieve better financial outcomes as well as better health outcomes for enrollees, as it has been shown to do in some employer plans.”

Larger MA plans may get more of a return on investment from participation, compared with smaller plans, Fingold continues. Also, a plan with a larger percentage of enrollees with the targeted diagnoses might be able to get results that are more statistically significant, although “it would really depend on the nature of each plan’s enrollment” and which of the four CMS-approved VBID intervention approaches the plan uses.

“The VBID model marks the first time CMS will test a [value-based] model in the Part C space,” Sheila Hanley, director of the policy and programs group at the Center for Medicare and Medicaid Innovation, told attendees at a recent informational webinar. Under the model, plans will target members with seven specific chronic conditions: diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease and mood disorders, according to VBC. The program will start in January 2017, and run for five years in seven states chosen for regional diversity and MA penetration rates: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.

Visit https://aishealth.com/archive/nvbc1015-01 to read the article in its entirety, including descriptions of CMS’s four VBID intervention approaches, as well as potential disadvantages to the program.

About AIS’s Value-Based Care News
AIS’s Value-Based Care News (VBC) delivers timely news, data and strategies related to ACOs, medical homes, bundled payments, coordinated care and global payments. Formerly published as ACO Business News, the 12-page newsletter focuses intently on value-based launches, products and results, and innovative arrangements that can help organizations improve the quality of care, lower costs and grow market share. Featuring the pros and cons of various strategies for different types of organizations, VBC is designed to help readers avoid the pitfalls ahead and transform exciting value-based care opportunities into winning business strategies. Visit http://aishealth.com/marketplace/value-based-care-news for more information.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AIShealth.com.

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