CMS Releases Updates to MA VBID Demonstration

On Friday, January 18, 2019, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released updates to the Medicare Advantage (MA) Value-Based Insurance Design Demonstration (VBID).

The MA VBID model began in a limited number of states in 2017.  For CY 2020, consistent with the Bipartisan Budget Act of 2018, MA plans in all 50 states and territories may apply.  The VBID model allows MA plans to offer varied plan benefit design for enrollees in certain clinical categories, including reduced cost sharing or additional services for targeted enrollees.

For 2020, CMS is planning to add flexibility for plans who choose to participate in the model.  Plans may test new interventions, including non-uniform benefit design or supplemental benefits based on condition and/or certain socioeconomic factors; MA and Part D rewards and incentives programs; increased access to telehealth services instead of in-person visits to meet certain provider network requirements; and timely, coordinated approaches to wellness and health care planning, including advanced care planning.  Beginning in 2021, VBID models will also test inclusion of the Medicare hospice benefit in MA.  Applications for 2020 are not yet available on the CMS website.

Simultaneously, the Innovation Center released the evaluation report for the first year of MA-VBID.  In 2017, there was no change in enrollment or projected revenue to plans.  Outcomes such as utilization, beneficiary health and quality performance could not be assessed until additional 2017 data become available.

More information is available on the demonstration model webpage here.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or Mara McDermott at 202-204-1462/