In December, the Medicare and Medicaid Service Centers (CMS) announced that the Insurance Design Model based on the Medicare Advantage value (VBID) At the end of 2025, due to the “substantial and inducible costs of the model for Medicare Trust Funds.” Calling the “unprecedented” costs in CMS innovation Center models, the VBID model cost CMS $ 2.3 billion in the calendar year (Cy) 2021 and $ 2.2 billion in Cy 2022. Although the model is finishing A year earlier, the lessons learned from this program can report design of the MA Future Ma Plan, said CMS.
As CMS explains on its website, since its launch in 2017, the VBID model has tested a variety of interventions of Ma health plans aimed at reducing Medicare spending and improving the quality of care for ma affiliates. It has also been based on CMS’s commitment to the transparency and health of the whole person in the MA program. Through the model, the participants’ plans have had the additional flexibility to go to potentially high value and assistance of shared costs for prescription medications to populations with chronic and unattended diseases, with the aim of increasing access and absorption of These services to improve health and decrease the avoidable medical spending of these affiliates.
VBID model background
CMS says that the VBID model has generated lessons that have reported broader policies of the MA program, including strategies for:
• Improve the health results of the population, enabled by the requirements of the model for MA plans to evaluate health -related social needs (HRSN), offer certain complementary benefits that address HRSN and implement health capital plans. In particular, the special complementary benefits for chronic patients (SSBCI), which can generally reflect VBID interventions, provide an opportunity for CMS to continue collaborating with plans and other partners in these initiatives throughout the MA program.
• Improve transparency in MA through new report requirements, for example, with respect to the use of complementary benefits by affiliates. These learnings have reported data collection efforts throughout the MA program, particularly with respect to the complementary benefits policy, CMS said.
• Increase adherence to medicines through the reduction of costs costs of part D, some of which were promulgated in the Law on Inflation Reduction (IRA) for all qualified beneficiaries, for example, around to the expansion of the low -income subsidies program under the part of Medicare D.
CMS said that the model’s performance analysis and policy options showed that substantial costs were partly driven by a greater growth of the risk score and the expenses of part D and that no modification of the viable policy could address excessive costs. As such, the model must be completed at the end of 2025 to meet the legal requirements of the CMS Innovation Center.
CMS said he was making the announcement more than one year before the date of validity of the termination to provide sufficient time for the ma plans and their associated organizations to prepare for CY 2026 so that it best supports the needs of its affiliates. In particular, as many of the VBID model interventions are now widely available in the MA program, the termination of the model will not affect the capacity of the MA plans to continue offering most of the interventions offered under the model. CMS added that it would also continue to promote the health, transparency and affordability of the entire person in the MA program and effectively administer the costs of the MA program to protect the beneficiaries and the Medicare trust funds.
In a interview with Health Affairs’ Jeff Byers, Mark Fendrick, MD, of the Insurance Design Center based on the value of the University of Michigan, explained that the risk adjustment is among the main drivers of the additional expenses to the Medicare trust funds. “It should not be a surprise since particularly from the beginning, Mabbid’s demonstration focused on specific chronic conditions that Ma plans really sought to identify the people who had these conditions. And given that these conditions often led to a higher expense, these patients also had higher risk scores, which again led CMS to pay higher payments, ”said Fendrick.
“The point on risk scores is really important because, as a doctor, if the precise codification of these patients with chronic diseases really led to interventions that led to better health, I think that the expense in the risk score is quite good” , Fendrick added. “However, if these coding changes were only to identify patients who are already receiving those treatments but led to higher income or payments, that expense, in my opinion, is not beneficial. We do not know that these billions of dollars are actually helping patients or simply helping plans. “
