The federal government will expand a new Medicare Advantage program to three states in 2018, as part of an effort to change behaviors and cost-sharing for seniors who have chronic diseases.
Last year, the CMS Innovation Center, created and funded by the Affordable Care Act, unveiled the five-year experiment, building on the request of doctors and consumer advocates who wanted to see more so-called value-based insurance design.
The concept behind VBID is to eliminate the financial barriers sick patients face when they are trying to get certain exams, prescriptions drugs and procedures. If patients with chronic conditions are able to obtain high-quality care that is recommended by doctors for free or at a reduced cost, in theory, they are more likely to get that care and avoid potentially more expensive care down the road. Cost-sharing likewise would increase for services that offer little to no value for patients.
Dr. Mark Fendrick, a physician at the University of Michigan and one of the original supporters of VBID, has championed a bill in Congress that would allow all private plans to provide first-dollar coverage for chronically ill people who are in a high-deductible policy.
Starting this January, interested Medicare Advantage insurers will be able to offer enhanced benefits in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee. In 2018, the project will expand to Alabama, Michigan and Texas. The CMS said a representative sample of Medicare Advantage enrollees live in those 10 states.
Next month, the CMS will disclose which health plans are participating next year. Officials with UnitedHealthcare, the largest Medicare Advantage insurer in the country, told Modern Healthcare last year they were interested in the program. Companies that want to try the VBID demo in 2018 can apply next year.
Aside from lower cost-sharing, plans in the demo can offer supplemental benefits, such as telehealth or nonemergency transportation to doctor visits.
However, companies can only offer the benefits to members who have diabetes, congestive heart failure, chronic obstructive pulmonary disease, past stroke, hypertension, coronary artery disease or mood disorders. Starting in 2018, that list will expand to include people with rheumatoid arthritis and dementia.
Participating plans must meet certain criteria, according to new Medicare details. For example, plans must have at least a three-star rating or higher, and they can't be under sanctions. That means Cigna Corp., whose Medicare Advantage plans were sanctioned in January for a host of problems, won't qualify. Cigna had 537,000 Medicare Advantage enrollees as of July.