Medicare Advantage

Value-Based Insurance Design

Health Solutions

October 12, 2015

The Center for Medicare & Medicaid Services (CMS), through the Center for Medicare & Medicaid Innovation (CMMI), announced the Medicare Advantage Value-Based Insurance Design (MA-VBID) Model Test and provided preliminary guidance to Medicare Advantage Organizations wishing to participate. The Value- Based Insurance Design (VBID) model will test the value of patient cost sharing and health plan benefit designs that encourage patients to seek high-value clinical services, leading to improved quality and reduced costs.

The model test is scheduled to begin on January 1, 2017 and continue for five years. CMS will conduct the model test in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. CMMI strongly encourages organizations interested in participating to begin designing programs and preparing proposals in advance of the formal Request for Application (RFA), as the expected deadline for application submission is December 2015.

FTI Consulting can assist MA-VBID eligible health plans with all aspects of implementing the MA-VBID model including: identifying chronic conditions and combinations of conditions to target; design and implement interventions for targeted populations; assist with plan marketing and enrollee communications; and develop financial projections as required by the application. FTI Consulting can tailor a program with some or all of the following services:

Identify Targeted Conditions and Combinations of Conditions to Include in Your VBID Model
CMS has identified a limited number of chronic conditions that organizations may choose to target. Participating organizations will be responsible for applying the CMS-defined criteria to enrollees who fall within each of the clinical categories selected by an organization and may be subject to randomized audits to determine if all VBID-eligible enrollees received interventions. The targeted conditions are:

  • Diabetes;
  • Chronic Obstructive Pulmonary Disease (COPD);
  • Congestive Heart Failure (CHF);
  • Patient with Past Stroke;
  • Hypertension;
  • Coronary Artery Disease; and,
  • Mood Disorders.

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