CMS has announced the Calendar Year (CY) 2022 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. There is a more than two-fold increase in the number of Model enrollees covered by participating MA plans in 2022 compared to 2021.
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 dually eligible beneficiaries and those qualifying for Low Income Subsidy (LIS) – 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 co-payments, and/or rewards and incentives that are anticipated to improve health and health equity by meeting 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 2022 VBID Model Participation
For CY 2022, VBID Model participation continued to build on the substantial growth seen in CY 2021 and CY 2020. For CY 2022, the VBID Model has 34 participating MA organizations (MAOs), up from 14 in 2020 and 19 in 2021. These 34 participating MAOs are testing the Model in 49 states, DC, and Puerto Rico through 1,014 plan benefit packages (PBPs), up from 30 states and Puerto Rico with 157 participating PBPs in 2020, and 45 states, DC, and Puerto Rico with 451 participating PBPs in 2021. A total of 7.8 million beneficiaries are projected to be enrolled in participating PBPs in 2022, an increase from approximately 1.2 million beneficiaries in 2020 and 4.6 million in 2021. Over 3.7 million beneficiaries are projected to receive additional supplemental benefits as part of the Model test in 2022, up from 280,000 in 2020 and 1.6 million in 2021.
Of the 34 MAOs participating in 2022, 13 are participating in the Hospice Benefit Component, four more than in 2021, the initial year of the Hospice Benefit Component. These 13 organizations will test the inclusion of the Part A hospice benefit in MA benefits through 115 PBPs (up from 53 PBPs in 2021) and in 461 counties (up from 206 counties in 2021). 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. Each participating MAO included as part of their palliative care strategy the following: palliative care consults, comprehensive care assessments and services provided by an interdisciplinary care team, care planning and goals of care discussions, advance care planning, 24/7 access and support, psychosocial and spiritual support, pain and symptom management, medication reconciliation, caregiver support and a focus on ensuring access to social services and community resources. In addition, participating MAOs are able to provide individualized, clinically appropriate transitional concurrent care through in-network providers and offer hospice-specific supplemental benefits.