2024年VBID有利于MA市场格局和2025年VBID模型应用考虑

March 2024 2024 VBID benefit MA market landscape2March 2024and 2025 VBID Model application considerationsCMS historically allowed MAOs to offer rewards and incentives (RI) under the VBID Model for both medical and pharmacyservices. Beneficiaries could receive some form of a cash equivalent given they meet the criteria for the benefit.7In the 2025VBID Model Request for Application (RFA), CMS announced it will be discontinuing the Part C RI Program due to the ability tooffer these flexibilities outside of this Model. The Part D RI program under the VBID Model will continue in 2025.8Similarly, Wellness and Health Care Planning (WHP) was included in the VBID Model to encourage discussions forbeneficiaries’ preference of care.9WHP is still required but will be discontinued in 2025 as a separate component given itswidespread adoption by MAOs.10The remainder of VBID discussion in this paper excludes VBID-H, RI, and WHP.VBID participation grew significantly in recent yearsThe VBID program has seen four years of steady growth from 2021 to 2024, as shown in Figure 1.FIGURE 1: PERCENTAGE OF BENEFICIARIES WITH VBID COVERAGE, 2021-202411Growth in VBID participation is evident in all plan types across the last four years.In 2021, 12% of all MA beneficiarieswere enrolled in a plan with a VBID offering, which grew to 36% in 2024.7 CMS, VBID Model Hospice Benefit Component Overview, op cit.8 CMS (December 13, 2023). Request for Applications for the Calendar Year 2025 Value-Based Insurance Design Model. Retrieved March 22, 2024, fromhttps://www.cms.gov/files/document/vbid-cy25-rfa.pdf.9 CMS. Request for Applications for the Calendar Year 2024 Value-Based Insurance Design Model. Retrieved March 22, 2024, fromhttps://www.cms.gov/priorities/innovation/media/document/vbid-cy-2024-rfa.10 CMS, Findings at a Glance, op cit.11 Institutional special needs plans (I-SNPs) were not included in any figures because very few I-SNPs participate in the VBID program.12%6%44%4%18%7%71%4%28%13%86%16%36%21%93%25%0%20%40%60%80%100%All PlansNon-SNPD-SNPC-SNP% of MA Enrollees2021202220232024Special Supplemental Benefits for the Chronically Ill(SSBCI) is a separate CMS benefitprogram that allows for many of the same benefit flexibilities as VBID. SSBCI does not have thesame application requirements as the VBID program, which can result in less administrativeburden on the MAO. However, SSBCI is more limited than VBID in the following ways:SSBCI only allows chronic conditions as qualifying conditions to receive SSBCI benefits. In VBID,plans can use low socioeconomic status and geographic areas to qualify members for VBID benefits.SSBCI does not allow for any Part D benefit flexibilities. 2024 VBID benefit MA market landscape3March 2024and 2025 VBID Model application considerationsDual-eligible special needs plans (D-SNPs) have the largest percentage of beneficiaries (93%) in plans that offer VBID in2024. MAOs can select low socioeconomic status as the eligibility criteria for a beneficiary to receive VBID benefits, anddual-eligible beneficiaries are likely to meet this criteria. This means D-SNPs can effectively offer VBID benefits—whichcannot be offered as mandatory supplemental benefits under the MA program—to all beneficiaries. It also allows foroffering Part D flexibilities to all beneficiaries, such as reducing Part D cost sharing for low-income beneficiaries withoutforfeiting CMS subsidies.Chronic and disabling condition special needs plans (C-SNPs) increased participation in the program from 4% ofbeneficiaries in 2021 to 25% of beneficiaries in 2024. Similar to D-SNPs, C-SNPs can effectively offer VBID benefits to allbeneficiaries by selecting the same eligibility requirements to receive VBID benefits as to enroll in the C-SNP. C-SNPs maybe more likely to use SSBCI to provide Part C benefit flexibilities to their beneficiaries, however, because through SSBCI theycan qualify all beneficiaries using chronic conditions and avoid the administrative burden of the VBID application. Theexistence of the SSBCI program may explain why C-SNPs have less VBID coverage compared to D-SNPs.VBID coverage for non-SNP plans was less than 10% of beneficiaries in 2021 and 2022, but more than doubled to21% in 2024.Non-SNP plans can enroll a wide range of beneficiaries given that there is no additional qualifyingenrollment factor, as is the case with SNPs. MAOs offering non-SNPs may question whether the cost of adding VBIDcoverage is worth the gain to a potentially small portion of their beneficiaries. Due to the ability to target Part D benefitflexibilities under VBID, which is unique to this demonstration program, non-SNP plans may see value in utilizing thisflexibility through VBID to target specific high-cost and high-incidence disease states for many MA beneficiaries, such asdiabetes or chronic obstructive pulmonary disease (COPD).Figures 2 and 3 show the same information as Figure 1 but split the view into national and regional carriers. National players