The Center for Medicare and Medicaid Services (CMS) announced late last week that they are expanding their Medicare Advantage Value Based Insurance Design (VBID) project (from Modern Healthcare)
Insurers in 25 states will be able to apply for the Medicare Advantage Value-Based Insurance Design Model in 2019, the CMS announced Wednesday. The program is available to insurers in 10 states in 2018.
Additionally, the federal government is tweaking the model to allow Chronic Conditions Special Needs Plans to participate, and allow participants to propose methods for identifying enrollees with different chronic conditions than those previously allowed by the CMS, such as lower back pain, chronic kidney disease, obesity, asthma or tobacco use.
The early results on the initial VBID project are not in yet. The major insurers involved are primarily trying to lower the costs of chronic care maintenance medications or lowering the costs of front end medical services.
The idea is to encourage people to use more low cost and effective services while making it comparatively more expensive and less likely for people to use low effectiveness services. This is an experiment that is worthwhile doing and it seems like it will be rolling out to enough areas that there will be a sufficiently wide evidence base to make reasonable judgements about benefit design by 2020.
satby
I hope this is the start of better targeted health care: lower cost, more effective would be great, especially if the data demonstrates it works.
Yutsano
@satby: (BTW it does no good to type out a reply to someone and then change pages before sending. I haven’t had enough bean juice yet this morning.)
This will be a good thing especially if we can get a 55 and over Medicare buy in in place by 2020 as well.
Sam Dobermann
The ACA built in a lot of ways to attack costs; incentivizing low cost front line care to prevent high cost needs was a big one. The no copay, pre deductible costs for the listed preventive care was first order. That applied to all forms of health care (HC) insurance even employer subsidized insurance.
This program is different. It is limited to the Medicare Advantage (MA) plans that apply for the program and includes patients with certain specific disorders or combinations of disorders. These are the highest cost patients overall and giving them better treatments will reduce total HC cost the quickest.
The disorders listed in the above essay are being added for this coming year. This year the conditions were the more serious such as COPD. CHF, Diabetes, coronary heart disease, mood disorders and some others. Insurers could pick which ones to include. (Apparently no plan picked mood disorders.)
People identified for these programs within their customer base could receive reduced cost sharing for high value services and drugs, for example no copays for eye exams for diabetics. Another way is reduce or eliminate copays for high value providers. Value would not be based on their costs but results. A third way is to reduce copays for enrollees who participate in a disease management program. The plans can condition the benefits on patients meeting certain criteria such as measuring their blood pressure daily.
It’s been shown that focusing on the highest risk and cost patients and basically wrapping them in needed, quality services you can reduce costs for the entire population the fastest. Furthermore, the benefits of various innovations will show up quicker so they can be generalized quickly.
Barbara
@Sam Dobermann: The biggest issue with these programs is getting provider buy in. MA enrollees are heavily influenced by their existing physicians relationships.
As for mood disorders — many elderly people still resist being identified as having any kind of mental illness. That’s probably why they used the term mood disorder. I wonder what the evidence is that this is really a cost driver for the Medicare program.
Sam Dobermann
@Yutsano: A 55 and over Medicare buy in is not a good idea. First it is an individual plan; one premium per person, not good at all with couple with kids. Second over 30% on Medicare chose a privatized Medicare plan. Original Medicare with its 20% copay requires other insurance for prescriptions. There are other problems with it. Medicare premiums only cover 25% of the costs; the rest come from the federal treasury.
What you may want is ability to buy into Medicaid. Its much more straight forward and the benefits are much, much better.
Medicaid expansion was the true Public Option that was put into the ACA. Obama and the team that created the ACA knew that it would be the workhorse of the program. We need to fight to expand Medicaid’s income limits a bit at a time until it swallows the whole. Or we could allow some buy-in.
Besides what saved the ACA repeal was the Governors and the Sates’ reaction to loosing a big chunk of their programs. Senators who voted against the whole repeal thought about their own states’ needs. Medicare is a federal program and its support is more diffuse.
There are a lot of good reasons why a single payer plan is NOT good for the US and the above is one.
It’s interesting that the experimenting on cost and quality for Medicare is being carried out by the various private entities that are the Advantage plans. They can test more different things to most quickly show what works and how well.
Barbara
@Sam Dobermann: People like the idea of Medicare because nearly everyone has a relative who has it and likes it. They don’t understand Medicare well enough to know its limitations, including probably being the number one driver of fragmented care and out of control medical inflation. They dismiss Medicaid, which has a bad reputation not because it is a bad program, but because it is so poorly funded. Medicaid with middle class enrollment could not get away with the kind of underfunding that bedevils an entitlement program focused on poor people (until expansion).
Sam Dobermann
@Barbara: Most of the parts of the @Barbara: Most of the parts of the VBID program would work without a provider change. The part about the high value provider is generally most often for the specialist care. The incentivizing for various disease management programs can be done as an add-on or with most providers. They ask patients to do what doctors want them to do, test the glucose levels or blood pressure regularly, and don’t cut the provider’s pay; just the patient’s copay.
Mood disorders are cost drivers especially because of their interactions with all the other conditions. Depression makes it hard to comply with self care, take medication in a timely manner — or at all. People with depression and other serious conditions wind up in the hospital far more often than those without a mood disorder. It may have changed since I last studied suicide but the elderly have one of the highest rates. Failed suicide attempts are usually costly. It is an area worth dealing with, however none of the VBID programs choose to include that in their programs.
Sam Dobermann
@Barbara: Medicaid is not a bad program and it doesn’t have to be underfunded. Even so it has a bad reputation because Republicans want it to. Anything for the poor must be considered bad, else how could you fight to end it. It has some of the problems Medicare has that Republicans work at amplifying. It’s going to have more. If the Tax Scam passes and blows up the deficit there will be an automatic cut of $25 Billion to Medicare.
To the Republicans that’s not a bug; that’s a feature.
I wonder if Susan Collins and Murkowski know that. Or any of the rest in the Senate?
Sam Dobermann
I haven’t mastered link yet. If you click on any of the last 2 lines it will take to to the WSJ article explaining the cut to Medicare and a bunch of other programs.
Steeplejack (phone)
@Sam Dobermann:
You have to close the link after you insert the actual hyperlink you want to go to. Once the “Enter the URL” window closes, position your cursor at the end of the text the reader will see and press the “link” button again. It will show up as “/link” until you close the link. Otherwise the unclosed link runs to the bottom of your comment and captures everything, including the Reply button.
Sam Dobermann
@Steeplejack (phone): Many thanks. Now I have no excuse.