Incorporating Clinical Value
into Coverage Design
Health Action Conference 2016
February 5, 2016
Stacy Sanders
Federal Policy Director
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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© 2016 Medicare Rights Center