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CMS selects insurers for Medicare Advantage value-based insurance design model

The model will run for five years starting January 1, 2017, in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services has selected nine Medicare Advantage organizations to participate in the 2017 value-based insurance design model.

The model will run for five years starting January 1, 2017 in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.

Three of the organizations chosen are in Massachusetts; five are in Pennsylvania; and one is in Indiana.

They are Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan of Massachusetts, Tufts Associated Health Plan of Massachusetts; Geisinger Health Plan, Aetna, Independence Blue Cross, Highmark and UPMC Health Plan of Pennsylvania; and Indiana University Health Plan.

[Also: CMS releases Medicare Advantage value-based insurance design model]

Existing Medicare Advantage requirements generally mandates that benefits and cost sharing be the same for all enrollees. 

Value-based insurance design tests the theory that flexibility in plans improves the quality of care while reducing costs. 

The model allows insurers of Medicare Advantage and MA Part D plans to offer cost sharing and other elements to encourage the use of clinical services that have the greatest potential to improve health.

Eligible plans, upon CMS approval, may offer varied benefits for enrollees who have certain clinical conditions including: diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, patient with past stroke, hypertension, coronary artery disease or mood disorders.

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Starting on Jan. 1, 2018, rheumatoid arthritis and dementia will be included in the model and Alabama, Michigan, and Texas will be added.

CMS expects to release a request for applications for the second year of the test this fall.

Participating plans may choose from four general approaches: Reduced cost sharing for high-value services such as eliminating co-pays for eye exams for diabetics; Reduced cost sharing for high-value providers, such as for diabetics who see a physician who has achieved strong results; Reduced cost sharing for enrollees participating in disease management or related programs, including elimination of primary care co-pays for diabetes patients who meet regularly with a case manager; and Coverage of additional supplemental benefits to targeted populations, including physician consultations via real-time interactive audio.

CMS generally restricts the model to plans with a minimum enrollment in the test states of 2,000 enrollees.

However, beginning in 2018, CMS said it would offer flexibility.

Additionally, plans must be rated by CMS at three stars or higher,  and must have been offered in at least three open enrollment periods. There is no cap on the total number of participating plans.

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