Medicare Advantage Value-Based Insurance Design Model

Through the Medicare Advantage Value-Based Insurance Design (VBID) Model, CMS is testing a broad array of complementary Medicare Advantage (MA) health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, including those with low incomes such as dual-eligibles, and improve the coordination and efficiency of health care service delivery. Overall, the VBID Model contributes to the modernization of MA and tests whether these model components improve health outcomes and lower expenditures for MA enrollees.

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MAVBID mapped

For plan year 2020, 14 Medicare Advantage Organizations (MAOs) (List) offering MA benefits to plan benefit packages (PBPs) with 1.2 million enrollees are providing tailored Model benefits and rewards and incentives to over 280,000 beneficiaries in 30 states and Puerto Rico.

Background

MA plans offer Medicare beneficiaries an alternative to Original Medicare, also referred to as “Fee-for-Service.” In addition to covering all Medicare services, some MA plans also offer Medicare beneficiaries extra coverage through supplemental benefits, such as vision, hearing, and dental services. Additionally, some MA Plans also offer prescription drug coverage (Part D) as part of their plan.

MA plans can charge different out-of-pocket costs for certain services within guidelines defined by Medicare. VBID generally refers to health insurers’ efforts to structure cost-sharing and other health plan design elements to encourage enrollees to use the services that can benefit them the most.

Additionally, currently, enrollees may enroll into MA and have access to all original Medicare benefits plus additional supplemental benefits beyond what original Medicare covers. When an MA enrollee elects hospice, Fee-For-Service (FFS) Medicare becomes responsible for most services while the MA organization retains responsibility for certain services (e.g., supplemental benefits). This hospice “carve-out” from MA results in a convoluted set of coverage rules for MA enrollees who elect hospice and fragments accountability for care and financial responsibility across the care continuum.

Initiative Details

The VBID  Model tests a broad array of MA service delivery and/or payment approaches and contributes to the modernization of MA through increasing choice, lowering cost, and improving the quality of care for Medicare beneficiaries.

The VBID Model will allow MA organizations to further target benefit design to enrollees based on chronic condition but also certain socioeconomic characteristics, such as low income status, including dually eligible beneficiaries. Also, MA Organizations may also offer the Medicare hospice benefit as described below. Additionally, the VBID model will require all participating plans to better engage their enrollees through structured and timely wellness and health care planning and allows participating plans to provide a potentially more impactful rewards and incentives program.

The service delivery model components CMS has made available to participating organizations for CY 2021 are:

  1. Value-Based Insurance Design by Condition, Socioeconomic Status, or both
  2. Rewards and Incentives
  3. Medicare Hospice Benefit
  4. Wellness and Health Care Planning (required for all VBID-participating plans)

Detailed information about each of these interventions is available in the documents available in the Model Information section below.

Hospice Benefit Component

The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in CY 2021, through the VBID Model, participating MA organizations could include the Medicare hospice benefit in their Part A benefits package.

Currently, enrollees may enroll into MA and have access to all original Medicare benefits plus additional supplemental benefits beyond what original Medicare covers. When a MA enrollee elects hospice, Fee-For-Service (FFS) Medicare becomes responsible for most services while the MA organization retains responsibility for certain services (e.g. supplemental benefits). This hospice “carve-out” from MA results in a convoluted set of coverage rules for MA enrollees who elect hospice and fragments accountability for care and financial responsibility across the care continuum.

By including the Medicare hospice benefit in the MA benefits package, CMS will test the impact on service delivery and quality of MA plans providing all original Parts A and B Medicare items and services required by statute. Additionally, CMS is testing how the hospice benefit component can improve beneficiary care through greater care coordination, reduced fragmentation, and transparency in line with recommendations by the Office of Inspector General (OIG), the Medicare Payment Advisory Commission (MedPAC) and others. CMS will require that MA organizations provide beneficiaries with broad access to the complete original Medicare hospice benefit. MA organizations participating in the hospice benefit component will be required to outline how they will provide palliative care to eligible enrollees, irrespective of the election of hospice, and may make transitional, concurrent care services as well as hospice-specific supplemental benefits available to enrollees who elect hospice through network hospice providers.

For more information, please reference the VBID Hospice Benefit Component Request for Applications (PDF).

How to Apply

Consistent with eligibility for the VBID Model in CY 2021, eligible MA Organizations in all 50 states and territories may apply for one or more of the VBID Model components.

For specific application instructions, please reference the

Interested organizations must apply online via an application by March 16, 2020 at 11:59 p.m. EST. The CY 2021 online application will be made available to applicants with the availability of the second CY 2021 VBID RFA. MA Organizations should reference the CY 2020 VBID RFA (PDF) for information on offering VBID by condition, socioeconomic status, or both, Medicare Advantage and Part D Rewards and Incentives, and Wellness and Health Care Planning (WHP). MA Organizations should reference the CY 2021 VBID Hospice Benefit Component RFA for application questions that will be captured through the online application.

For questions regarding the VBID model, please contact VBID@cms.hhs.gov.

Additional Information

CY 2021 Materials

CY 2020 Materials

Webinars

CY 2020 Webinars & Recordings

  • coming soon

CY 2020 Webinars & Recordings

Evaluation Reports