Medicare Advantage Value-Based Insurance Design: The Second Year

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Medicare Advantage Value-Based Insurance Design: The Second Year

April 5, 2018

The Center for Medicare & Medicaid Innovation (CMMI) is now in its second year of implementation of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model test, a pilot project measuring the potential for value-based insurance design (VBID) in the Medicare Advantage program. In the model test, participating Medicare Advantage Organizations (MAOs), which ordinarily offer Medicare Advantage and Part D benefits to each of their plan enrollees at the same level of uniform coverage and cost sharing, can offer extra coverage or reduced cost sharing to enrollees with CMMI-specified chronic conditions.
Manatt Health Strategies analyzed which MAOs are participating in the VBID model test in 2018 and what value-based approaches are being used in their individual plans (also known as plan benefit packages (PBPs)) for which disease conditions. Our findings for CY 2018 show that MAOs generally preserved their approaches from 2017, and continue to focus on diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and hypertension (HPN). Additionally, participating MAOs are mostly reducing cost sharing for medical benefits as their key VBID approach, occasionally in combination with extra coverage of services or reduced cost sharing for Part D drugs. These data give insight into how other MAOs may approach VBID in 2019, when CMS makes the flexibility available to MAOs nationwide.