2024 Tests Expansion of Medicare Advantage Value-Based Insurance Design Model

Article Highlights The value-based insurance design model will be required to address health-related social needs in at least two of three health-related social needs areas: food, transportation, and housing insecurity and/or living environment, and improve care coordination. Get the changes affecting hospice and the list of 2024 participants. 2024 will test the expansion of the Medicare Advantage value-based insurance design model. Here’s what to expect. The value-based insurance design model (VBID) has 69 participating Medicare Advantage Organizations (MAOs). 13 of the 69 MAOs participating in the VBID Model in 2024 are participating in the hospice benefit component. MAOs are incorporating the Medicare hospice benefit into MA covered benefits while offering comprehensive palliative care services outside the hospice benefit for enrollees with serious illnesses. Beginning in CY 2024, all participants in the VBID model are required to submit a VBID Health Equity Plan (HEP) that provides a detailed strategy for advancing health equity as part of their approach to participation in the Model. 4 million enrollees projected to be enrolled in participating plan benefit packages (PBPs) More than7 million of these enrollees are projected to be offered additional model benefits and/or rewards and incentives as part of the model test in 2024. What’s Changing in 2024 In Calendar Year (CY) 2024, the VBID model will test model components. All participating MAOs must participate in the mandatory wellness and health care planning component of the VBID model in 2024. Participating MAOs may also test one or more of the other interventions in CY 2024. Wellness and Health Care Planning (WHP). VBID Flexibilities, for model PBPs’ select enrollees targeted by condition, socioeconomic status or a combination of both, for offering a) primarily and non-primarily health related supplemental benefits, which may include new and existing technologies or FDA-approved medical devices as a mandatory supplemental benefit; b) use of high-value providers and/or participation in care management program(s)/ disease state management program(s); and c) reductions in cost-sharing for Part C items and services and covered Part D drugs. Part C and Part D Rewards and Incentives Programs. Hospice Benefit Component. Phase 3 Begins in 2025; Extends Through 2030 The Medicare Advantage VBID model will be extended for calendar years 2025 through 2030 and will introduce changes intended to address the health-related social needs of patients, advance health equity, and improve care coordination more fully for patients with serious illness. The third phase of the model will include several new policies. First, MAOs in the model will be required to offer supplemental benefits to address health-related social needs in at least two of three health-related social needs areas: food, transportation, and housing insecurity and/or living environment. Those benefits would be targeted to meet enrollees’ needs and could include benefits such as meals beyond a limited basis, transportation to medical appointments, air conditioning units to support enrollees in areas experiencing extreme heat, and housing assistance. Under the current version of the model, MAOs can offer benefits to address health-related social needs, but they are not required. Other flexibilities, including the ability to offer reduced cost sharing for Part D drugs, will remain a core part of the model. Second, the model will introduce a new flexibility for MAOs to address health-related social needs in socioeconomically disadvantaged areas, using the Area Deprivation Index, to direct benefits to enrollees in underserved communities. While existing VBID model flexibilities have allowed for focus on health-related social needs, current targeting criteria (namely Part D LIS and dual-eligible status) are based on income, and therefore, miss enrollees who still may be relatively disadvantaged, and have health-related social needs, but do not qualify for these programs. Third, the model will require additional data collection to heighten CMS’s understanding of how enrollees are using supplemental benefits and their impact on enrollees. The CY 2025 request for applications will introduce changes intended to address the health-related social needs of patients, advance health equity, and improve care coordination more fully for patients with serious illness. View the organizations participating in the 2024 VBID model Download ArticleDownload the Entire Issue

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2024 Tests Expansion of Medicare Advantage Value-Based Insurance Design Model

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