Feature | Radiology Business | September 03, 2015

CMS Announces New Value-Based Insurance Design Model for Medicare Advantage Plans

Model designed to improve care and reduce costs for enrollees with chronic conditions, providing more individually tailored care options

CMS, Medicare Advantage, Value-Based Insurance Design model, VBID, chronic conditions

September 3, 2015 — The Centers for Medicare & Medicaid Services (CMS) announced the creation of the Medicare Advantage Value-Based Insurance Design Model, designed to improve care and reduce costs in Medicare Advantage plans. The new model will test the hypothesis that giving these plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees with specified chronic conditions can lead to higher-quality and more cost-efficient care.

The goal of the model is to improve beneficiary health, reduce utilization of avoidable high-cost care, and reduce costs for plans, beneficiaries and the Medicare program. The model focuses on Medicare Advantage enrollees with the chronic conditions of diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders and combinations of these categories.

“The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer.

The model is intended to improve outcomes and reduce costs by giving health plans the flexibility to provide new supplemental benefits specifically tailored to the enrollees’ clinical needs, such as the elimination of co-pays for eye exams for beneficiaries with diabetes or extra tobacco cessation assistance for enrollees with COPD. The model will begin Jan. 1, 2017, and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.

Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care and reduce the cost of care for Medicare Advantage enrollees with chronic diseases.

The new model was developed by the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center was created by the Affordable Care Act to test innovative healthcare payment and service delivery models that have the potential to reduce Medicare, Medicaid and Children’s Health Insurance Program expenditures while preserving or enhancing the quality of beneficiaries’ care.

For more information: www.innovation.cms.gov

Related Content

Videos | Radiology Business | August 02, 2019
Association for Medical Imaging Management (AHRA) President ...
Feature | Information Technology | July 31, 2019 | By Greg Freiherr
Innovation is trending toward improved efficiency — but not at the expense of patient safety, according to...
Demand for ultrasound scans at U.S. outpatient centers could grow by double digits over the next five years, according to a speaker at AHRA 2019. A variety of factors, however, could cause projections for this and other modalities to change. Graphic courtesy of Pixabay

Demand for ultrasound scans at U.S. outpatient centers could grow by double digits over the next five years, according to a speaker at AHRA 2019. A variety of factors, however, could cause projections for this and other modalities to change. Graphic courtesy of Pixabay

Feature | Radiology Imaging | July 29, 2019 | By Greg Freiherr
The coming years may be good for the medical imaging community in the United States. But they will not be easy.
Body language expert Traci Brown spoke at the AHRA 2019 meeting on how to identify when a person is not being honest by their body language. She said medical imaging department administrators can use this knowledge to help in hiring decisions and managing staff.

Body language expert Traci Brown spoke at the AHRA 2019 meeting on how to identify when a person is not being honest by their body language. She said medical imaging department administrators can use this knowledge to help in hiring decisions and managing staff. 

Feature | Radiology Business | July 23, 2019 | Greg Freiherr
Can you tell when someone is lying?
John Carrino, M.D., M.Ph., presents “Challenges and Opportunities for Radiology to Prove Value in Alternative Payment Models” at AHRA 2019

John Carrino, M.D., M.Ph., presents “Challenges and Opportunities for Radiology to Prove Value in Alternative Payment Models” at AHRA 2019. Photo by Greg Freiherr

Feature | Radiology Business | July 22, 2019 | By Greg Freiherr
Efforts to reform healthcare are booming, b
Radiology, medical imaging, is facing declining reimbursements, imaging departments continue to comprise a significant portion of the revenue stream in most healthcare organizations. Stewards of these departments are continuously looking for ways to optimize efficiency, increase patient and staff satisfaction, and lower costs without compromising the delivery of excellent patient care. Image by rawpixel from Pixabay

Image by rawpixel from Pixabay 

Feature | Radiology Business | July 18, 2019 | By Stefanie Manack and Judy Zakutny
Approximately 30 percent of a hospital or health system’s profit comes from imaging according, to...
CMS Proposes New Alternative Payment Model for Radiation Oncology
News | Radiation Oncology | July 17, 2019
The Centers for Medicare and Medicaid Services (CMS) issued a proposal for an advanced alternative payment model (APM)...