Humana, UnitedHealthcare, WellCare, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Plains Alliance and CVS Health are among those participating in the Part D model that gives insurers financial incentives when they offer innovative programs that encourage seniors to take their medications.
The experiment comes out of the Affordable Care Act and affects an estimated 1.6 million Medicare beneficiaries.
Evidence suggests that medication therapy services currently offered by Part D plans don't improve quality or reduce unnecessary medical expenditures. That's likely due to misaligned financial incentives and regulatory constraints, the agency said.
The focused approach is critical, experts say. “The rationale is that Medicare Advantage plans currently have more of an incentive than stand-alone Part D plans to work with patients to take their medications because they are on the hook for hospitalizations,” said Tricia Neuman, senior vice president of the Kaiser Family Foundation's program on Medicare policy.
Participating plans will find ways to optimize medication use and improve care coordination.
The model will launch Jan.1, 2017, in Arizona, Florida, Iowa, Louisiana, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Virginia and Wyoming. These areas were chosen because of their geographic and demographic variance and spending patterns.
Following CMS approval, Part D plans in these regions can vary the intensity and types of medication therapy interventions they provide based on beneficiary risk level. They can also seek out a range of strategies to individualize beneficiary and prescriber outreach and engagement.
Depending on how well plans perform in this new experiment, they'll be eligible for an increased beneficiary premium subsidy.
On Monday, the CMS also announced it was expanding a new Medicare Advantage value-based insurance design model to three states in 2018.
The program aims to place patients with chronic conditions in high-quality care. The belief is that they are more likely to get that care and avoid potentially more expensive care down the road if it is provided to them free or at a reduced cost. Alternately, seniors who choose low value services would contribute more to their premiums.
The Medicare Advantage value-based insurance design model will begin Jan. 1, 2017, and run for five years. In its first year, the CMS will test the model in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.
