West Health Policy Center Commends CMS for Testing Value-Based Insurance Design Model in Medicare Advantage Plans


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San Diego, CA and Washington, D.C. – The West Health Policy Center commends the Center for Medicare and Medicaid Services’ plans for testing an innovative value-based insurance design (VBID) model in seven states to improve care delivery and increase payment incentives for Medicare Advantage enrollees with chronic conditions.

Research shows that applying value-based insurance design can increase patient access and use of ongoing preventive care to more effectively manage chronic conditions,” said Joseph M. Smith, MD, PhD, FACC, president of the West Health Policy Center. “This move reinforces other positive, innovative efforts like the extension of the Independence at Home program from CMS’ Innovation Center, representing a growing understanding of the importance plan design, value-based incentives and new care delivery models can play in increasing access to higher-quality care at lower cost for our nation’s seniors.”

According to the Innovation Center, the VBID Model will begin January 1, 2017 and run for five years. CMS will test the model in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Eligible Medicare Advantage plans in these states, upon approval from CMS, can offer varied plan benefit design for enrollees who fall into certain clinical categories identified and defined by CMS. Changes to benefit design made through this model may reduce cost-sharing and/or offer additional services to targeted enrollees; however, targeted enrollees can never receive fewer benefits or have to pay higher cost-sharing than other enrollees as a result of the model.