On September 1, 2015, CMS unveiled a new Medicare Advantage Value-Based Insurance Design (MA-VBID) model, which will allow Medicare Advantage plans to offer clinically-nuanced benefit packages aimed at improving quality of care while also reducing costs.

The MA-VBID model supports high-value clinical services, improved health outcomes, and health care cost savings or cost neutrality through the use of structured patient cost sharing and other health plan design elements that encourage enrollees to use high-value clinical services.  Under the model, Medicare Advantage plans will develop clinically-nuanced benefit designs for enrollee populations that fall within certain specified clinical categories.

For each of the selected clinical categories, participating plans may select one or more plan design modifications from one the following four approaches: reduced cost sharing for high-value services, reduced cost sharing for high-value providers, reduced cost sharing for enrollees participating in disease management or related programs and coverage of additional supplemental benefits.

The MA-VBID model will begin January 1, 2017, and will run for five years.  The model will be tested in the following seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.  CMS will accept applications for the MA-VBID model via a Request for Applications (RFA) that will be available online shortly.

To view CMS’s fact sheet, click here.  The RFA, once released, will be available here.

Reporter, Isabella Edmundson, Atlanta, GA, + 1 404 572 3527, iedmundson@kslaw.com.