Through the Value-Based Insurance Design (VBID) Model, CMS is testing a broad array of complementary Medicare Advantage 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. The VBID Model contributes to the modernization of Medicare Advantage and tests whether these model components improve health outcomes and lower expenditures for Medicare Advantage enrollees.
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.
The VBID model tests a broad array of Medicare Advantage service delivery and/or payment approaches and contributes to the modernization of Medicare Advantage 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 dual eligibles. 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 and to meet network adequacy requirements using access to telehealth services.
The service delivery model components CMS has made available to participating organizations for CY 2020 are:
- Value-Based Insurance Design by Condition, Socioeconomic Status, or both
- Rewards and Incentives
- Telehealth Networks
- 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.
Beginning in the 2021 plan year, the VBID model will also test allowing Medicare Advantage plans to offer Medicare’s hospice benefit. This change is designed to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians.
For questions regarding the VBID model, please contact VBID@cms.hhs.gov.
How to Apply
Interested organizations must apply through the online application portal through March 15, 2019 at 11:59 p.m. EST. The 2020 application portal will be made available to applicants in early February 2019 through the same link.
- Fact Sheet (PDF) (updated 01/18/2019)
- Press Release
- Request for Applications (PDF)
- Applicant Instructions (PDF)
- Actuarial Guidance (PDF)
- HPMS Language (PDF)
- Medicare Advantage Value-Based Insurance Design Model - CY2020 Design Application Cycle (Wednesday, January 30, 2019)
- Medicare Advantage Value-Based Insurance Design Model - Model Year One Findings (Thursday, February 14, 2019)
- Medicare Advantage Value-Based Insurance Design Model and Part D Payment Modernization Model - Deep Dive (Thursday, February 28, 2019)
- Medicare Advantage Value-Based Insurance Design Model - Hospice Intervention (Tuesday, April 9, 2019)