U.S. Sens. John Thune (R-S.D.) and Debbie Stabenow (D-Mich.) today praised the Center for Medicare & Medicaid Innovation (CMMI) for establishing a Medicare Advantage (MA) demonstration program to evaluate how value-based insurance design (V-BID) could reduce copayments and coinsurance for certain high-value medications and services for some MA enrollees with specific chronic conditions. CMMI’s decision comes just months after Thune and Stabenow introduced legislation that highlighted this need.
“I applaud CMMI’s effort to solve a central challenge in reforming America’s health care system — testing policy solutions that lower the cost of health care while simultaneously improving patients’ health outcomes,” said Thune. “With V-BID, both patients and taxpayers win, demonstrating that it’s possible to improve the value of care delivered when money is spent in a more targeted, effective way.”
“Testing this new, innovative model is an important step towards lowering the costs of critical services and helping Medicare patients better manage their chronic illnesses,” said Senator Stabenow. “This model is rooted in work being done at the University of Michigan and will help people with chronic conditions get the treatments they need for the best overall value. I look forward to seeing this program expand nationwide to help improve quality of care and lower insurance costs for even more seniors.”
V-BID is an insurance design concept that reverses the current one-size-fits-all approach to cost-sharing by embracing the simple, yet transformative idea that prices for prescription drugs and services should be structured to motivate patients to make healthy choices. When patients forgo high-value medications or health care services due to cost, they are more likely to suffer adverse and often serious events that could have been prevented, ultimately driving up the cost of care. Studies show that reducing or eliminating copayments for high-value prescription drugs can increase their utilization, and ultimately improve clinical outcomes and lower health care expenditures.
CMMI will allow participating MA plans the option to use V-BID benefits to lower copayments and coinsurance and offer supplemental benefits. This will encourage the use of specific, evidence-based medications or clinical services and/or specific high-performing providers. To protect seniors, it also explicitly prohibits plans from increasing copayments or coinsurance to discourage use of services.