Medicare Expands Value Based Plans

by  Wyn Staheli, Director of Content - innoviHealth
Nov 28th, 2017

In 2015, the CMS Innovation Center announced plans for new value-based Medicare Advantage plans in an effort to reduce healthcare costs while improving quality of care. This five year pilot program began in 2017 with seven states and is expanding to ten states for 2018. Results must have been positive because they recently announced that the program will expand to 25 states in 2019 and TRICARE will also begin to pilot this program in 2018.

Value-Based Insurance Design (VBID) is focused on encouraging patients, especially those with chronic conditions, to better manage their health and thus decrease costs while producing better patient outcomes. This is typically accomplished through financial means such as lowering co-payments which makes it easier for these patient to get the care that they need. Commercial plans have been utilizing VBID for some time and results shows that it can be an effective tool to improve quality of care and reduce costs. For example, chronically ill patients can now afford to take the prescribed medications to properly manage their conditions.

For 2017, the chronic conditions included are:

• diabetes
• congestive heart failure
• chronic obstructive pulmonary disease (COPD)
• past stroke
• hypertension
• coronary artery disease
• mood disorders
• combinations of these categories

The list of conditions will expand for 2018 to also include dementia and rheumatoid arthritis.