More private payers will participate in Medicare Advantage’s voluntary value-based insurance design (VBID) next year, the Centers for Medicare and Medicaid Services reported on Thursday.
The number of participating organizations will increase from 10 to 14, and the number of beneficiaries will more than double, from 440,000 in 2019 to 1.2 million in 2020. Coverage will also expand from seven states to 30 states and Puerto Rico.
Companies participating next year include:
- CVS Health Corp. (Aetna Inc.)
- Blue Cross Blue Shield of Michigan
- Blue Cross Blue Shield of Rhode Island
- CareOregon Inc.
- Capital District Physicians’ Health Plan Inc.
- Highmark Health
- Humana Inc.
- Innovacare Inc.
- Medical Card System, Inc.
- New York City Health and Hospitals Corp.
- Sentara Health Care
- UnitedHealth Group, Inc.
- UMPC Health System
- WellCare Health Plans, Inc.
CMS first began testing the value-based insurance design model in 2017, with the goal of offering insurance plans that can increase the quality of care while also reducing costs. CMS first implemented the program for Medicare Advantage providers in seven states and has since expanded it.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
According to an evaluation report released by CMS in February, nine of 23 eligible organizations participated in the VBID model in 2017. Of the 96,000 beneficiaries that were eligible for the new model, 61 percent actually received VBID benefits.
In January, CMS opened the VBID model to plans in all 50 states. The agency also made several changes that would allow participating organizations to design plans based on socioeconomic status or health condition, offer rewards and incentives programs, offer access to telehealth services, and better coordinate wellness and care planning. Those changes will go into effect for plans starting in 2020.
Starting in 2021, CMS will also begin testing the inclusion of the Medicare hospice benefit in Medicare Advantage plans. Medicare Advantage organizations that want to participate in the VBID model in 2021 have until June 1 to finalize their plan benefit designs.
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