Proposed Bipartisan Bill, 2018 Budget Deal Provide Positive Implications for VBID

As value-based insurance design (VBID) continues to gain and maintain bipartisan support, the last week alone saw 2 bills introduced or passed with positive implications for the concept.

On February 8, Senators John Thune, R-South Dakota, and Tom Carper, D-Delaware, and Representatives Diane Black, R-Tennessee, and Earl Blumenauer, D-Oregon, introduced the Chronic Disease Management Act of 2018.

According to the bill, a small number of chronic diseases account for the majority of US healthcare spending, and limited and targeted interventions for many chronic diseases may prevent the need for additional and more costly therapies associated with untreated chronic diseases that lead to adverse effects on quality of life. Therefore, chronic care preventive services should be encouraged in order to maximize the effectiveness of the care provided under high-deductible health plans (HDHPs).

The bill states, “Allowing health savings account—eligible HDHPs to cover chronic disease prevention and treatment on a pre-deductible basis promotes the concept of VBID, which is an effective tool to improve the quality and reduce the cost of care for Americans with chronic diseases.”

"This bipartisan health reform bill allows for the development and voluntary implementation of clinically nuanced HDHPs with the potential to enhance patient-centered outcomes, allow for lower premiums, and substantially reduce healthcare expenditures," said A. Mark Fendrick, MD, director of the Center for V-BID and co-Editor-in Chief of The American Journal of Managed Care^® (AJMC^®), in a statement to AJMC^®. "This innovative HDHP would provide millions of Americans a plan option that better meets their clinical and financial needs."

Just a day later, President Trump signed the Bipartisan Budget Act of 2018. Incorporated in the bill is the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which extends the Center for Medicare & Medicaid Innovation Medicare Advantage (MA) VBID Model to all 50 states by January 1, 2020.

The model will provide HDHPs the flexibility to reduce cost sharing or offer supplemental benefits to enrollees with specified chronic conditions, focusing on the services that are of the highest clinical value to them, according to a V-BID Center press release. HDHPs will have the ability to provide coverage for services that manage chronic disease prior to meeting the plan’s deductible.

“The nationwide expansion of the MA V-BID Model Test provides MA plans in all 50 states the flexibility to create benefit designs that promote personal responsibility, improve patient centered outcomes, and lower healthcare expenditures," said Fendrick in a statement to AJMC^®. "The incorporation of VBID principles into the Medicare program will allow payers, beneficiaries, and taxpayers to achieve better health for every dollar spent."

As VBID underscores the importance of clinically nuanced benefit design and applicability for both public and private payers, the concept has consistently maintained bipartisan support. Over the last year, progress was made across several fronts for VBID, including the launch of the MA-VBID Model test with the goal of assessing the utility of structuring consumer cost sharing and other plan elements to encourage the use of high-value clinical services and providers for beneficiaries with specified chronic conditions. 2017 also brought the identification of the top 5 low-value clinical services for purchasers to target for reduction, put forward by VBID Health’s Task Force on Low-Value Care.