University of Michigan
CC/Andrew Horne

I just got the following note from Mark Fendrick, MD, Director of the Center for Value-Based Insurance Design at the University of Michigan and a tireless campaigner on behalf of VBID:

“Today, Representatives Diane Black (R-TN-06) and Earl Blumenauer (D-OR-03), introduced H.R. 5183 — the Value-Based Insurance Design (V-BID) for Better Care Act of 2014 — a bipartisan measure that allows Medicare Advantage (MA) plans to utilize V-BID to reduce the copayments or coinsurance for beneficiaries with specific chronic conditions.”

As a long time member of the Advisory Board of the Center and a big fan of value-based insurance design, I am thrilled to see this announcement.  We are in the beginning of the middle phase of payment reform – this first phase was just getting people to acknowledge that fee-for-service was not just a problem, but a huge problem.  As Farzad Mostashari recently told me, it’s “Fee for Service that is the enemy.”

Mark Fendrick MD, Director of Center for VBID at University of Michigan
Mark Fendrick MD, Director of Center for VBID at University of Michigan

Progress is being made.  Thank you Mark and everyone at the Center for the work you do.

Here is the Congressional announcement:

Black, Blumenauer Introduce the VBID for Better Care Act of 2014

Bipartisan legislation would allow Medicare Advantage plans to reduce certain copayments or coinsurance for beneficiaries to drive better health care outcomes and lower costs.

Washington, D.C. – Today, Reps. Diane Black (R-TN-06) and Earl Blumenauer (D-OR-03), both members of the House Ways and Means Committee, introduced H.R. 5183 — the Value-Based Insurance Design (VBID) for Better Care Act of 2014 — a bipartisan measure that would establish a regional demonstration program for high-quality Medicare Advantage (MA) plans to utilize V-BID to reduce the copayments or coinsurance for beneficiaries with specific chronic conditions. In doing so, beneficiaries are provided with increased access to the care they need to ensure better health outcomes.  V-BID allows plans with the flexibility needed to offer the best possible care coordination for disease management, and provides the right incentives for beneficiaries.

“As a nurse for over 40 years, improving our nation’s health care system by implementing policies that help promote patient-centered care and provider accountability is a top priority of mine in Congress,” said Congressman Black. “Specifically, this legislation would allow Medicare Advantage plans the flexibility to improve how care is delivered by allowing them to use VBID practices that give beneficiaries access to lower costs for certain medications or services that are clinically proven to have good health outcomes.  Such flexibility has the potential to not only improve beneficiary outcomes, but also to promote cost transparency and encourage greater efficiencies within the health plans. Essentially, this creates an incentive for providers to have better outcomes – and at lower costs.”

“There is a growing body of evidence showing individuals forgo necessary care as their out-of-pocket costs increase,” said Congressman Blumenauer. “This demonstration project will allow high-quality plans to lower out-of-pocket costs  for the care that beneficiaries need most—building upon private market initiatives already taking place in Oregon and around the country. By reducing or eliminating such costs for medically necessary drugs or services, it will be easier for seniors in MA to get evidence-based care, manage chronic conditions, and follow their treatments.”

Specifically, this legislation:

  • Directs the Secretary of Health and Human Services to establish a demonstration program to test V-BID methodologies in MA plans for beneficiaries with chronic clinical conditions (i.e. increased access to insulin for people with diabetes or beta blockers for people with heart disease);
  • Allows MA plans the option to use V-BID benefits to lower copayments and coinsurance to encourage the use of specific, evidence-based medications or clinical services and/or specific high-performing providers;
  • Explicitly prohibits plans from increasing copayments or coinsurance to discourage use of services;
  • Requires an independent review, assessment, and report on the impact of the demonstration program; and
  • Expands the demonstration program to allow all MA plans to pursue V-BID should the report conclude the demonstration has lowered costs and increased quality for beneficiaries.

Click here for bill text.

If you want to learn more about the V-BID Center, go here:www.vbidcenter.org.


 

Value-Based Insurance Design (V-BID) was conceptualized and developed by a multidisciplinary team of faculty at the University of Michigan’s Center for Value-Based Insurance Design.  To learn more about the V-BID Center and ongoing research, please visit www.vbidcenter.org.

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