5 changes to CMS’ Medicare Advantage value-based model

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CMS is refining its Medicare Advantage Value-Based Insurance Design model for 2018.

The Medicare Advantage Value-Based Insurance Design test was announced in September 2015 to measure if value-based insurance approaches to Medicare Advantage plans can improve quality of care and lower costs.

The model will begin Jan. 1, 2017, and run for five years.

Here are five changes CMS will apply for its second model year in 2018.

1. CMS will open the model to new insurer applicants. Nine insurers will participate in 2017.

2. Alabama, Michigan and Texas will be added to the model. For 2017, Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee will participate in the test.

3. Rheumatoid arthritis and dementia will be added to insurers’ benefit packages. For 2017, the model focuses on Medicare Advantage enrollees with the following chronic conditions: diabetes, congestive heart failure, chronic obstructive pulmonary disease, past stroke, hypertension, coronary artery disease and mood disorders.

4. CMS will make adjustments to existing clinical categories.

5. The minimum enrollment size for Medicare Advantage and Medicare Advantage Part D plan participants will be decreased from 2,000 enrollees to 500 enrollees in instances where a participating carrier already has one plan with at least 2,000 enrollees. 

CMS will release a request for applications for 2018 this fall.  

More articles about payer issues:
State-by-state look at ACA individual marketplaces
CMS selects 6 insurers for Medicare Part D medication model
State-by-state changes in uninsured rates from 2010-15

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