Incorporating Clinical Value into Coverage Design

Health Action Conference 2016February 5, 2016

Stacy SandersFederal Policy Director

© 2016 Medicare Rights Center

V-BID in Medicare Advantage “The model will test the hypothesis that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to enrollees with CMS-specified chronic conditions, to encourage the use of services that are of highest value to them, will lead to higher-quality and more cost-efficient care.” – CMS Innovation Center

Testing model in 7 states• AZ, IN, IA, MA, OR, PA, TN

5 year demo beginning January 1, 2017 CMS currently reviewing applications

© 2016 Medicare Rights Center

V-BID in Medicare Advantage CMS-specified chronic conditions: Diabetes Chronic Obstructive Pulmonary Disease Congestive Heart Failure Patient with Past Stroke Hypertension Coronary Artery Disease Mood disorders

© 2016 Medicare Rights Center

V-BID in Medicare Advantage

Tests the following strategies:

Reduced cost sharing for the following:

• High-value services

• High-value providers

• Disease management programs

Additional supplemental benefits

© 2016 Medicare Rights Center

V-BID in Medicare Advantage

Critical consumer protections:

Only lowered cost sharing allowed

Limitations on V-BID marketing

Prohibitions on low-rated and sanctioned plans

Secret shoppers and 1-800-MEDICARE scripts

Minimum beneficiary education requirements

© 2016 Medicare Rights Center

V-BID in Medicare Advantage

What to watch for in demo rollout:

Transparency in model design

Criteria for determining high-value care

Access to high-value providers

Education initiatives beyond the minimum

Ongoing stakeholder engagement

© 2016 Medicare Rights Center

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