CMS Fields New Pilot Program to Bolster Medicare Advantage

August 16, 2016 11:03 am News Staff

CMS has announced further details of a pilot project that will test whether permitting health plans to be more flexible with incentives can improve health outcomes or reduce costs for Medicare Advantage enrollees who have certain chronic conditions.

[Physician listening to senior man's heart]

The Medicare Advantage Value-based Insurance Design (VBID) initiative( will allow Medicare Advantage plans to offer supplemental benefits or reduced cost-sharing to encourage patients to use clinical services that can improve their health outcomes while reducing overall cost.

The demonstration program will begin in 2017 in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee for patients who have diabetes, congestive heart failure, chronic obstructive pulmonary disease, a history of stroke, hypertension, coronary artery disease, mood disorders or combinations of these categories.

On Aug. 10, CMS announced( that the plan will expand in 2018 to include Alabama, Michigan and Texas and will add patients with dementia and rheumatoid arthritis. The states were chosen because they are considered to be representative of the national Medicare Advantage market, encompassing both urban and rural areas, areas with both high and low average Medicare expenditures, and areas with high and low prevalences of low-income subsidies.

CMS to Host Webinar on VBID Pilot Year Two

Please join CMS for a webinar discussing the second year of the Medicare Advantage Value-based Insurance Design model test on Aug. 24 at 2 p.m. EDT. Registration and more information are now available(

VBID enrollees might see reduced costs, and they are guaranteed not to see reduced benefits or costs higher than those in existing Medicare Advantage plans.

The demonstration project targets the hidden costs of care, notably copayments. For instance, VBID participating plans could eliminate primary care copayments for patients with diabetes who meet regularly with a case manager, and patients with heart disease could pay less for prescription drugs if they regularly monitor and report their blood pressure.

And although Medicare Advantage overall does not reimburse physicians for video consults, the VBID participating plans could. Such technology could be used, for example, for patients with diabetes or those who are in tobacco cessation programs.

CMS will announce which Medicare Advantage plans will participate for the first year in September 2016. The agency will begin the applications period for 2018 during the fall of 2016. To be eligible, plans must meet minimum quality standards and must cover at least 2,000 patients.

Related AAFP News Coverage
CMS Aims to Reduce Costs in Medicare Advantage Plans
Applications for Value-based Insurance Design Model Available Soon