The CMS is so invested in a demonstration meant to encourage use of clinically valuable services as a way to lower out-of-pocket costs for enrollees that it is asking for feedback on how to improve the program before it even launches.
The demonstration is part of the Affordable Care Act's push to lower healthcare costs and improve clinical quality in the Medicare program. The Medicare Advantage Value-Based Insurance Design Model kicks off Jan. 1, 2017, and will run for five years.
Value-based insurance design refers to health plans that waive or lower out-of-pocket costs for healthcare and prescription drugs that are proven effective for patients with chronic health conditions. For example, a plan might lower co-payments and other cost-sharing for diabetes exams and drugs in the hopes of lowering the long-term health costs for those patients.
Eligible Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee are participating in the initiative. The agency has yet to release the name of the plans and hasn't responded to a request for those names.
But the CMS recently asked industry stakeholders to offer feedback on the program.
In year one, the demonstration will focus on Medicare Advantage members who have diabetes, congestive heart failure, chronic obstructive pulmonary disease, a history of stroke, hypertension, coronary artery disease or mood disorders.
The CMS wants feedback on ways to promote quality of care and reduce cost of care for enrollees in the Medicare Advantage program.
It also asks for specific recommendations for additional clinical conditions that the CMS should consider including in future model years. The agency also is curious whether Medicare Advantage plans should be permitted to propose new conditions as part of the annual application process.
The agency also wants feedback on how to update the process for picking plans involved in the demonstration, including timelines and any necessary alterations to an online response portal where application would be submitted. Suggestions are due by April 18.