The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2022 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. There is a more than two-fold increase in the number of Model enrollees covered by participating MA plans in 2022 compared to 2021.
Through the VBID Model, CMS is testing a broad array of MA health plan innovations designed to enhance the quality of care for Medicare beneficiaries – including those with low income, such as dually eligible beneficiaries and those qualifying for Low Income Subsidy (LIS) – as well as to reduce costs for enrollees and the overall Medicare program. As part of the Model test, MA plans offer additional supplemental benefits, reduced co-payments, and/or rewards and incentives that are anticipated to improve health and health equity by meeting social needs – such as food and transportation, to engage enrollees in improving their care by receiving high-value services or participating in health-related activities, and to reduce financial barriers to access
CY 2022 VBID Model Participation
For CY 2022, VBID Model participation continued to build on the substantial growth seen in CY 2021 and CY 2020. For CY 2022, the VBID Model has 34 participating MA organizations (MAOs), up from 14 in 2020 and 19 in 2021. These 34 participating MAOs are testing the Model in 49 states, DC, and Puerto Rico through 1,014 plan benefit packages (PBPs), up from 30 states and Puerto Rico with 157 participating PBPs in 2020, and 45 states, DC, and Puerto Rico with 451 participating PBPs in 2021. A total of 7.8 million beneficiaries are projected to be enrolled in participating PBPs in 2022, an increase from approximately 1.2 million beneficiaries in 2020 and 4.6 million in 2021. Over 3.7 million beneficiaries are projected to receive additional supplemental benefits as part of the Model test in 2022, up from 280,000 in 2020 and 1.6 million in 2021.
Of the 34 MAOs participating in 2022, 13 are participating in the Hospice Benefit Component, four more than in 2021, the initial year of the Hospice Benefit Component. These 13 organizations will test the inclusion of the Part A hospice benefit in MA benefits through 115 PBPs (up from 53 PBPs in 2021) and in 461 counties (up from 206 counties in 2021). In participating in this voluntary Model component, MAOs are incorporating the Medicare hospice benefit into MA covered benefits while offering comprehensive palliative care services outside the hospice benefit for enrollees with serious illness. Each participating MAO included as part of their palliative care strategy the following: palliative care consults, comprehensive care assessments and services provided by an interdisciplinary care team, care planning and goals of care discussions, advance care planning, 24/7 access and support, psychosocial and spiritual support, pain and symptom management, medication reconciliation, caregiver support and a focus on ensuring access to social services and community resources. In addition, participating MAOs are able to provide individualized, clinically appropriate transitional concurrent care through in-network providers and offer hospice-specific supplemental benefits.
The following MAOs are participant partners in the CY 2022 VBID Model:
- Alignment Healthcare USA, LLC
- Anthem, Inc.
- Athena Healthcare Holdings, LLC
- AvMed, Inc.*
- Banner Health
- Blue Cross Blue Shield of Michigan Mutual Ins. Co.
- Blue Cross Blue Shield of Rhode Island
- Cambia Health Solutions, Inc.*
- CareOregon, Inc.
- Capital District Physicians’ Health Plan, Inc.
- Catholic Health Care System*
- CIGNA
- CVS Health Cooperation*
- DevotedHealth, Inc.
- EmblemHealth
- Geisinger Health
- Hawaii Medical Service Association*
- Health Partners Plans, Inc.
- HealthFirst, Inc.
- Highmark Health
- Humana, Inc.*
- Intermountain Health Care, Inc.*
- Kaiser Foundation Health Plan, Inc.*
- Medical Card System, Inc.
- New York City Health and Hospitals Corporation
- Presbyterian Healthcare Services*
- Reliance HMO, Inc.
- Sentara Health Care (SHC)
- Summit Master Company, LLC*
- Triple-S Management Corporation*
- Troy Holdings, Inc.
- Ultimate Healthcare Holdings, LLC
- UnitedHealth Group, Inc.*
- Visiting Nurse Service of New York*
*Indicates participation in the Hospice Benefit Component of the VBID Model for CY 2022
FOR INFORMATION ON THE 2022 VBID MODEL, PLEASE CLICK HERE
FOR INFORMATION ON THE HOSPICE BENEFIT COMPONENT, PLEASE CLICK HERE
Model Background
The VBID Model began in January 2017 and will be tested through December 2024. The Model is designed to test whether furnishing certain flexibilities in coverage and payment for MAOs, to promote MA health plan innovations, would reduce Medicare program expenditures, enhance the quality of care Medicare beneficiaries receive, including dual-eligible beneficiaries, and improve the coordination and efficiency of health care service delivery.
Several changes have been made to the VBID Model since its initial implementation in 2017, all with the goal of testing additional flexibilities that we believe contribute to the modernization of the MA program. CMS is conducting this Model test through the CMS Innovation Center under section 1115A of the Social Security Act.
VBID originally tested allowing MAOs to structure enrollee cost-sharing and other plan design elements to encourage enrollees to use high-value clinical services, first for a limited set of conditions in a limited set of states, then removing that limitation on the original set of conditions and increasing included states in 2018 and 2019. In January 2019, for the 2020 plan year, CMS announced a broad array of changes, including allowing MA plans to provide reduced cost sharing and additional benefits to enrollees based on chronic condition, socioeconomic status, or both, even for non-primarily health related benefits, provide higher value Part C rewards and incentives, provide Part D rewards and incentives and requiring participating plans have a strategy to improve beneficiary wellness and health care planning. CMS was also required, through the Bipartisan Budget Act of 2018, to begin testing the Model in all 50 states and territories.
Additionally, in January 2019, CMS announced that beginning in CY 2021, through the Model, participating MAOs could apply to test the Medicare hospice benefit as a covered benefit. CMS chose to announce this component of the VBID Model almost two years in advance of the initial performance year to allow all stakeholders, including CMS, MAOs, palliative and hospice care providers, beneficiary advocate groups, and others, to work together on how to ensure quality and safety for beneficiaries through the Model component. CMS is grateful for the broad engagement, support, and perspectives we have received from stakeholders and will continue to work with palliative and hospice care providers, MAOs, and all others in extending current relationships and building new ones in support of a successful CY 2021 implementation.
In March 2020, CMS announced two new components of the VBID Model for CY 2021: (i) testing the impact of offering beneficiaries a mandatory supplemental benefit in the form of cash or monetary rebates, available to all enrollees in a participating plan benefit package (PBP); and (ii) removing any disincentives for MA plans to cover items and services that make use of new and existing technologies that are not covered by original Medicare.
The large number of flexibilities continually added to the Model since its inception in 2017 has enabled a growing number of MAOs to participate in the Model test, which in turn means more enrollees are offered more diverse benefits as we test whether these flexibilities decrease costs or improve quality of care. CMS plans to publicly report on early impacts and experiences with the Model next year.
CY 2023 VBID Request for Applications
Building on the continued growth and success of the VBID Model, CMS will target to release its request for applications for CY 2023 in early winter 2022. CMS will release a separate CY 2023 request for applications for the Hospice Benefit Component as well, and later in early winter 2022.
For more information please visit https://innovation.cms.gov/initiatives/vbid