CMS will soon begin soliciting applications from plan sponsor participants that wish to test innovative benefit designs in the third year of the Medicare Advantage Value-Based Insurance Design (VBID) model and may be providing greater flexibility to participating plans, as indicated in a September request for information (MAN 9/21/17, p. 1). As MA organizations weigh the potential risks and rewards of offering a VBID program, officials from CMS and UPMC Health Plans, Inc. recently shared lessons learned from the first year of the model that began on Jan. 1, 2017.

Introduced in September 2015, the five-year VBID test gave MA plans in seven states the flexibility to offer targeted extra benefits or reduced cost-sharing to enrollees with at least one of seven chronic conditions. CMS for the second year (2018) of the model included three more states and two additional targeted conditions. Yet as of now, the participants are nine MA organizations operating 11 plans in just three states, and at least two health plans have reported lower-than-anticipated enrollment in their programs.

During a well-attended session of the America’s Health Insurance Plans National Conference on Medicare, held Sept. 24-26 in Washington, D.C., VBID Model Lead Stephen Jenkins said CMS has had “a lot of interest” from plans in other states but that there have been various reasons why they decided not to participate in the model. “I would say my general takeaway is people are waiting to try and see what other people are doing before they take their first step,” he told attendees. He added that CMS has projected that the VBID programs can reach about 71,000 eligible beneficiaries out of 430,000 total plan enrollees.

Many eyes are on UPMC, one of the few participants that have publicized the details of their initiatives. Offered in Western Pennsylvania, the “Spark Your Health” program is designed to promote self-management in members with congestive heart failure and diabetes, CHF and chronic obstructive pulmonary disease (COPD) or all three conditions. Jenkins said most participating sponsors have chosen to target diabetes, COPD and CHF, or a combination of two of those conditions.

Spark Your Health features a health assessment survey, personalized quarterly activities and a direct reimbursement for Part C cost sharing. Members receive a $25 check for completing the initial survey, and can continue to receive $25 on a quarterly basis and up to $150 annually for taking certain steps.

Separate Member Services Line Is Key

A critical piece of implementation was setting up a dedicated VBID member services line for handling questions, directing members to the appropriate care manager and programs and allowing members to check on their status and payments, Helene Weinraub, vice president for Medicare with UPMC, told attendees at the conference.

While it’s been only eight months since the program was launched, early experience indicates that member services, data flow, care management and interdepartmental collaboration are all working well. Yet out of the 14,000 eligible members identified for the program, roughly 2,600 completed the initial survey — which was lower than UPMC had initially anticipated — and about 500 people that fit the program criteria have died since the start of the model. “That’s what happens with older, sick populations, so the question is, did we pick the right or the wrong population?” asked Weinraub.

Engaging Members Is Part of Challenge

VBID participants had to submit proposed changes for the 2018 plan year by Jan. 31, 2017. With only 31 days of experience to build on, one of the modifications it incorporated to improve member engagement was to shorten the initial survey, allow them to complete it over the phone rather than on paper, and combine it with a subsequent personal health review so that they can complete it and earn $50 instead of $25 in one step. “We really do expect that to work a lot better. Then they’ll just call, be able to conduct that survey right away and then figure out the care plan right away,” said Weinraub. And as members talk to one another about the money they’re earning, UPMC’s hope is more people will be inclined to join the program, she added.

For future years, she said UPMC is looking at more items it can reward members for, such as flu shots, and using bank cards instead of check payments. And she stressed that throughout the VBID process, CMS has been a collaborative and flexible partner.