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The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2023 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. The estimated number of Medicare enrollees covered by participating MA plans will increase by more than 24% in 2023 compared to 2022.
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 beneficiaries who qualify for the Low-Income Subsidy (LIS) or, in certain areas, dually eligible beneficiaries — 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 cost sharing, and/or rewards and incentives that are anticipated to improve health and health equity by offering items and services to meet health-related 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 2023 VBID Model Participation
For CY 2023, VBID Model participation continued to build on the substantial growth seen in CY 2022 and CY 2021. For CY 2023, the VBID Model has 52 participating MA organizations (MAOs), up from 34 in 2022 and 19 in 2021. These 52 participating MAOs are testing the Model in 49 states, DC, and Puerto Rico through 1,368 plan benefit packages (PBPs), up from 448 PBPs participating in 45 states, DC, and Puerto Rico in 2021, and 1,014 PBPs participating in 49 states, DC, and Puerto Rico in 2022. A total of 9.3 million beneficiaries are projected to be enrolled in participating PBPs in 2023, an increase from approximately 4.7 million beneficiaries in 2021 and 7.5 million in 2022. Over 6.0 million beneficiaries are projected to be offered additional supplemental benefits, and/or additional rewards and incentives, as part of the Model test in 2023, up from 1.6 million in 2021 and 3.7 million in 2022.
Of the 52 MAOs participating in 2023, 15 are participating in the Hospice Benefit Component, six more than in 2021 and two more than in 2022. These 15 organizations will test the inclusion of the Part A hospice benefit in MA benefits through 119 PBPs (up from 53 PBPs in 2021 and 115 PBPs in 2022) and in 806 counties (up from 206 counties in 2021 and 461 counties in 2022). 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. In addition, participating MAOs are able to provide individualized, clinically appropriate transitional concurrent care through in-network providers and offer hospice-specific supplemental benefits. Each participating MAO prepared health equity plans on how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care as it relates to their participation in the Hospice Benefit Component. Additionally, the Innovation Center is standardizing access- and equity-focused network adequacy requirements for MAO participants that have at least one year of participation by the start of CY 2023. Data files further describing the quantitative element of these network adequacy requirements will be released on the VBID Model website in the coming months.
The following MAOs are participant partners in the CY 2023 VBID Model:
Alignment Healthcare USA, LLC
AllCare Health, Inc.
AlohaCare
Athena Healthcare Holdings, LLC
Banner Health
Blue Cross & Blue Shield of Rhode Island
Blue Cross and Blue Shield of North Carolina
Blue Cross Blue Shield of Arizona
BlueCross BlueShield of Tennessee
Bright Health Group, Inc.
Cambia Health Solutions, Inc.*
Capital District Physicians’ Health Plan, Inc.
CareOregon, Inc.
Catholic Health Care System*
Centene Corporation
Chinese Hospital Association
CIGNA
Commonwealth Care Alliance, Inc.
Community Health Group
Community Health Plan of Washington
CVS Health Corporation*
Devoted Health, Inc.
DOCTORS HEALTHCARE PLANS, INC.
Elevance Health, Inc.*
EmblemHealth, Inc.
Geisinger Health
Guidewell Mutual Holding Corporation*
Hawaii Medical Service Association*
Healthfirst, Inc.
HealthPartners, Inc.
Henry Ford Health System
Highmark Health*
Humana Inc.*
INLAND EMPIRE HEALTH PLAN
Kaiser Foundation Health Plan, Inc.*
Louisiana Health Service & Indemnity Company*
Marquis Companies I, Inc.*
MHH Healthcare, L.P.
New York City Health and Hospitals Corporation
Presbyterian Healthcare Services*
SANTA CLARA COUNTY HEALTH AUTHORITY
SCAN Group*
Sentara Health Care (SHC)
The Health Plan of West Virginia, Inc.
Thomas Jefferson University
Triton Health Systems, L.L.C.
Troy Holdings, Inc.
Ultimate Healthcare Holdings, LLC
UnitedHealth Group, Inc.*
Universal Health Services, Inc.
UPMC Health System
Visiting Nurse Service of New York*
*Indicates participation in the Hospice Benefit Component of the VBID Model for CY 2023
FOR INFORMATION ON THE 2023 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 (as defined as being eligible for the LIS or, in US territories, being dual eligible), or both (even for non-primarily health related benefits), provide higher value Part C rewards and incentives, provide Part D rewards and incentives, and require participating plans to 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 implementation in CY 2021 and CY 2022.
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) (Cash or Monetary Rebates component); 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 Traditional Medicare. CMS has since discontinued the Cash or Monetary Rebates component of the VBID Model for CY 2023.
In CY 2023, participants in the VBID Model also have the option of participating in a voluntary Health Equity Incubation Program. The goal of the Health Equity Incubation Program is to help drive a critical mass of interventions in the most promising focus areas (e.g., around addressing food and nutritional insecurity), optimizing design and implementation best practices for interventions focused on health equity, and building and sharing an evidence base for quality improvement and medical savings related to interventions that address health-related social needs.
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 in the coming months.
CY 2024 VBID Request for Applications
Building on the continued growth and success of the VBID Model, CMS aims to release its request for applications for CY 2024 in early winter 2023. CMS will release a separate CY 2024 request for applications for the Hospice Benefit Component as well in early winter 2023.
For more information please visit https://innovation.cms.gov/initiatives/vbid.
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