New Medicare Advantage Pilot To Test Value-Based Insurance Design

On Tuesday, the Center for Medicare and Medicaid Innovation at CMS announced a new pilot program that will allow Medicare Advantage insurers to lower beneficiaries’ out-of-pocket costs as a way to encourage them to use high-quality services and potentially reduce overall costs in the long term, Modern Healthcare reports.

The five-year program begins Jan. 1, 2017. CMS will explain the model in more detail in a webinar on Sept. 24 (Herman, Modern Healthcare, 9/1).

Program Details

The Medicare Advantage Value-Based Insurance Design Model will allow an insurer to take one of four approaches when designing a plan:

  • Eliminate or lower cost-sharing for high-value services and items, including some Medicare Part D drugs;
  • Eliminate or lower cost-sharing for high-value health care providers;
  • Provide full coverage for “supplemental benefits” — including telemedicine for diabetes management and tobacco cessation — for some populations; or
  • Lower cost-sharing for members who participate in disease-management programs (CMS fact sheet, 9/1).

CMS Deputy Administrator Patrick Conway said the pilot “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.”

The pilot program will focus on beneficiaries with:

  • Diabetes;
  • Chronic obstructive pulmonary disease;
  • Congestive heart failure;
  • Coronary artery disease;
  • A history of stroke;
  • Hypertension; or
  • Mood disorders.

For the program, CMS chose states that were “generally representative of the national Medicare Advantage market,” including:

  • Arizona;
  • Indiana;
  • Iowa;
  • Massachusetts;
  • Oregon;
  • Pennsylvania; and
  • Tennessee (Modern Healthcare, 9/1).

Source Link

Recommended Articles

White House Leaves One Trump-Era Policy Alone

The Biden administration has gutted many of former President Donald Trump’s health care policies, but there’s one that the White House has yet to touch, Kelly reports. It’s a 2019 rule that expanded individual coverage health reimbursement arrangements, or ICHRAs, which allowed employers to provide tax-exempt subsidies to help workers purchase Obamacare plans. The Biden administration’s ...

Read More

Court Strikes Down HHS Rule that Allowed Insurers to Not Count Copay Assistance

In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and ...

Read More

Lawmakers, Payers And Providers All Air Grievances With Federal No Surprises Act Implementation

Amid a flurry of partisan roadblocks rolling out across Capitol Hill, representatives on both sides of the aisle came together Tuesday to critique federal agencies’ rollout of the No Surprises Act and throw their support behind court-ordered rewrites of independent dispute resolution (IDR) regulations. During a hearing exploring the “flawed implementation” of the law intended ...

Read More

As Biden Plans To Ban Medical Debt From Credit Scores, Advocates Press For More Change

The dramatic impact of medical debt on credit scores may soon be a thing of the past. On Thursday, the White House announced a plan outlined by the Consumer Financial Protection Bureau (CFPB) to eliminate medical debt from credit reports. The move — which follows an earlier decision from the three main credit bureaus to eliminate paid medical debt, medical ...

Read More
arrowcaret-downclosefacebook-squarehamburgerinstagram-squarelinkedin-squarepauseplaytwitter-squareyoutube-square