VBID
Medicare Advantage Value-Based Insurance Design Model
Through the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model, CMS tested a broad array of MA health plan innovations. These innovations aimed to enhance the quality of care for Medicare enrollees, including those with low income, and reduce costs for enrollees and the overall Medicare program. The model allowed participating MAOs to further target benefit design to enrollees based on chronic health conditions, Low-Income Subsidy eligibility, or place of residence.
Innovation
Allowed MA plans to target benefit design to enrollees based on chronic health conditions, LIS eligibility, or Area Deprivation Index (ADI) data, and tested the inclusion of the Medicare hospice benefit directly within the MA benefits package.
The Problem
A variety of factors including financial strain, limited access to healthy foods and transportation, and unmanaged chronic health conditions can prevent patients from seeking health care, but current rules make it hard to reach certain patients. Additionally, the historical hospice 'carve-out' from MA results in a convoluted set of coverage rules and fragments accountability for care across the care continuum.
The Solution
The VBID Model helped remove obstacles to health care by allowing participating MA plans to provide tailored supplemental benefits such as lower costs for prescription drugs, grocery assistance, transportation services, and support managing chronic conditions. It also tested including the Medicare hospice benefit in the MA benefits package to improve care coordination and reduce fragmentation.
Expected Outcomes
Improved health outcomes, lowered costs for MA enrollees, enhanced quality of care, greater care coordination, reduced fragmentation, and transparency in care delivery.
Strategy
The VBID Model contributed to the modernization of MA through increasing choice, lowering cost, and improving the quality of care for Medicare enrollees, aligning with person-centered approaches to care.
Model Goals
- Enhance the quality of care for Medicare enrollees
- Reduce costs for enrollees and the overall Medicare program
- Remove obstacles to health and health care
- Improve beneficiary care through greater care coordination and reduced fragmentation
Patient Eligibility
Medicare Advantage enrollees, specifically targeting those with chronic health conditions, Low-Income Subsidy (LIS) eligibility, dual eligibility, or based on place of residence (ADI data).
- Enrolled in a participating Medicare Advantage plan
- Has one or more chronic health conditions
- Eligible for Low-Income Subsidy (LIS) or dually eligible for Medicare and Medicaid
- Place of residence based on Area Deprivation Index (ADI) data
Provider Eligibility
Medicare Advantage Organizations (MAOs) offering MA plans.
- Must be a Medicare Advantage Organization (MAO)
Care Categories
Chronic Disease Management
End-of-Life Care
CMS Benchmarks & Thresholds
financial
operational
population
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