The Hospital & Healthsystem Association of Pennsylvania (HAP) has revealed that Pennsylvania will serve as one of seven test states for a new Medicare Advantage insurance model aimed at achieving higher-quality, more cost-efficient healthcare.
The prototype plan, a Value-Based Insurance Design (VBID) initiated by the Centers for Medicare & Medicaid Services (CMS), will commence Jan. 1, 2017, and continue for a five-year period, with CMS’s goals being to improve enrollees’ health, avoid high-cost care and reduce costs for plans and beneficiaries as well as Medicare.
Medicare Advantage will extend flexibility to health plans, offering extra supplemental benefits or reduced co-pays for enrollees suffering from specific conditions, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, past stroke, hypertension, coronary artery disease, mood disorders or combinations of these categories.
The insurance model will allow each enrollee group to choose one of four approaches for their plan customization, with three involving reduced cost sharing -- for high-value services, high-value providers or disease management program enrollees -- and the fourth option creating supplemental benefit coverage, such as physician consultations using real-time interactive audio and video for diabetics.
CMS will conduct an introductory webinar on Sept. 24, 2015. Consumers or providers can access information at http://innovation.cms.gov/initiatives/VBID/.
Other participating states include Arizona, Oregon, Tennessee, Iowa, Indiana and Massachusetts.
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