Are We Any Closer To VBID-X?

Yes and no, but keep an eye on CMS' growing Value-Based Insurance Design model.

VBID-X sounds like a medication. Should you ask your doctor if VBID-X right for you?

Probably—but you'll need your insurer's help too.

VBID-X (Value-Based Insurance Design) is a model plan that designates healthcare services as either high or low value based on clinical evidence. VBID-X proposes low-to-no cost sharing for high-value services and higher cost sharing for low-value ones.

While VBID-X plans don't technically exist, VBID's footprint is in more places than you might think. And it got a strong start with CMS' VBID innovation model.

This exploration of VBID in Medicare Advantage (MA, and other plan types) is part of HealthLeaders' Payer Week—five days of in-depth coverage spotlighting the significant roles and contributions of health insurers.

VBID: What, when and where

Only a few of CMS' value-based care (VBC) models have included MA plans and VBID is one of them. The other three are the Part D Senior Savings Model, Oncology Care Model (OCM, replaced by the Enhanced Oncology Model), and ACO REACH.

Since its 2017 inception, VBID has expanded from:

• Seven states to 50, the District of Columbia, and all U.S. territories;
   
• Seven disease states to any chronic condition; and
   
• Chronic conditions only to social drivers of health (SDOH), reward and incentive programs, telehealth, wellness and healthcare planning, and hospice benefits.

For CY2023, CMS added a voluntary Health Equity Incubation Program.

The pioneers, newbies, early outs, and nationals

Since 2017, VBID has grown from nine to 50-plus MA Organizations (MAOs), with these callouts:

• The pioneers: Among national MA plans, only Aetna—now a CVS Health company—has participated since 2017. Other early adopters include Highmark Health and BlueCross BlueShield of Michigan; the latter left in 2023.
   
• Newbies: While new entry is not surprising for startups like Bright Health Group, it is for nationals like Centene, which only joined VBID in 2023.
   
• Early outs: Some regional plans that could join VBID in 2017 left the model after only two years, including BCBS-MA and Independence Blue Cross.
   
• The nationals: Humana and UnitedHealth Group have participated in VBID since at least 2020. Cigna and Elevance Health joined in 2022.
   

VBID results so far

In December 2022, Duke University Press summarized a few CMS VBID results (2017-2019):

• Utilization: More member use of high-value services (e.g., primary and specialty care visits, medication adherence)
   
• Savings: While VBID did not generate savings in its first three years, the program proved cost neutral to Medicare.
   
• Increased Customization: More members are receiving more diverse, customized benefits—a projected 3.7 million in 2022 and a 300%-plus increase since 2020 (767,124).

How should these results be evaluated? Broadly and longitudinally.

VBID did not generate savings through 2019, but even cost neutrality is a positive for Medicare. VBID's low-but-growing enrollment is also a positive. Better to start small when the delivery system's future is at stake.

But perhaps the most important way to evaluate VBID is its ripple effect.

From demonstration to national benefit design model?

CMS demonstrations can help codify national changes. CMS' Part D Senior Savings model piloted the $35 per month insulin cost-sharing cap that will extend to all Medicare beneficiaries thanks to the Inflation Reduction Act.

CMS' VBID model has had a similar effect. Duke University Press notes it has influenced standardized VBID benefit design—the previously mentioned VBID-X—among state-run Exchanges, other CMS pilots targeting nonmedical supplemental benefits, and certain allowable Health Saving Account payments.

The Center for VBID at the University of Michigan believes that health equity may provide the next push that VBID-X needs. The Center laid much of the groundwork for VBID-X. And its director, Dr. Mark Fendrick, has encouraged hesitant payers to realize they've already embraced VBID as part of ACA requirements—and to go further.

"I'm not suggesting this is going to save the US health care system, but if you're interested in walking the walk, about changing your benefit design to improve individual and population health and especially with a motivation to enhance equity, these are the things I would suggest you do," Fendrick said.

CMS has extended VBID through 2030. This means that the model you've probably heard less about than MSSP or ACO REACH may drive the next generation of payer-led MA value-based benefits.

Delivery system fingers crossed.