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Medicare Advantage Value-Based Insurance Design Model
On April 5th, 2023, CMS announced the extension of the Value-Based Insurance Design (VBID) Model.
The VBID Model aims to increase use of high value services, while increasing flexibility of participating Medicare Advantage organizations to provide targeted supplemental benefits to meet the needs of their enrolled population.
Starting in calendar year (CY) 2024, the VBID Model will be testing several model components, some new and some existing. Participating health plans will be required to engage in the Wellness and Health Care Planning component of the VBID Model in CY2024 in addition to testing one or more of the other interventions in CY2024. These model components include:
- Wellness and Health Care Planning (WHP)
- VBID Flexibilities (Model PBPs’ select enrollees targeted by condition, socioeconomic status or a combination of both)
- Part C and Part D Rewards and Incentives (RI) Programs
- Hospice Benefit Component
VBID 101: What You Need to Know About VBID
Key VBID Facts:
- Members must earn or redeem rewards and/or incentives within the contract year in which the program has been implemented. Gift cards can be considered an acceptable form of reward or incentive so long as they are not redeemable for cash by the member.
- Medicare Advantage Organizations may include information about the VBID program in marketing materials, so long as those materials are provided equitably to all current and prospective enrollees without discrimination.
- The VBID program cannot be used to specifically target populations as potential enrollees.
Reporting
Participating organizations must report supplemental benefit utilization to CMS twice annually. Included in this reporting requirement under the Flexibilities component are supplemental benefits for food and nutritional insecurity, transportation barriers and living supports.
Reporting Requirements: (From CMS MA Reporting Technical Manual)
- 15.1 Do you have a Rewards and Incentives Program(s)? (“Yes” or “no” only)
- 15.2 What health related services and/or activities are included in the program?
- 15.3 What reward(s) may enrollees earn for participation?
- 15.4 How do you calculate the value of the reward?
- 15.5 How do you track enrollee participation in the program?
- 15.6 How many enrollees are currently enrolled in the program?
- 15.7 How many rewards have been awarded so far?
Core Program Elements
The core elements of the VBID Model cover health care planning, supplemental benefit provision, rewards and incentives and extra hospice support. Health plans can apply to tailor the optional elements based on CMS provisions to best meet member needs.
Health Equity Plan A New VBID Element in 2024
Starting with the 2024 VBID Model, each plan is required to submit a VBID Health Equity Plan. This contains the health plan’s strategy to advance health equity through participation in the VBID Model.
Key Elements:
- Health plans must identify priority populations and screening tools that will be used to capture disparities and health-related social needs.
- Health plans must define the actions that they will take to address the identified disparities, overcome potential barriers and refer members to appropriate support services.
- Health plans must present information on metrics and monitoring approach for the strategies presented in the Health Equity Plan.
- Finally, health plans must explain their education and engagement strategies for members as well as providers, caregivers and broader communities.
Preparing for Success
Participating health plans should expect to receive provisional approval on their CY2024 Medicare Advantage VBID applications in Mid-May.
Is your plan equipped to implement your VBID model in 2024? Medicare Advantage Organizations must consider their supplemental benefit vendor readiness, strengthening their quality and population health programs and ensuring medical management preparation for the new VBID program year.
ProspHire’s Medicare experts are prepared to support your organization in planning for VBID success.
