1. Incorporating Clinical Value into Coverage Design Health Action Conference 2016 February 5, 2016 Stacy Sanders Federal Policy Director

2. © 2016 Medicare Rights Center V-BID in Medicare Advantage “The model will test the hypothesis that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to enrollees with CMS-specified chronic conditions, to encourage the use of services that are of highest value to them, will lead to higher-quality and more cost-efficient care.” – CMS Innovation Center  Testing model in 7 states AZ, IN, IA, MA, OR, PA, TN  5 year demo beginning January 1, 2017  CMS currently reviewing applications

3. © 2016 Medicare Rights Center V-BID in Medicare Advantage CMS-specified chronic conditions:  Diabetes  Chronic Obstructive Pulmonary Disease  Congestive Heart Failure  Patient with Past Stroke  Hypertension  Coronary Artery Disease  Mood disorders

4. © 2016 Medicare Rights Center V-BID in Medicare Advantage Tests the following strategies:  Reduced cost sharing for the following: High-value services High-value providers Disease management programs  Additional supplemental benefits

5. © 2016 Medicare Rights Center V-BID in Medicare Advantage Critical consumer protections:  Only lowered cost sharing allowed  Limitations on V-BID marketing  Prohibitions on low-rated and sanctioned plans  Secret shoppers and 1-800-MEDICARE scripts  Minimum beneficiary education requirements

6. © 2016 Medicare Rights Center V-BID in Medicare Advantage What to watch for in demo rollout:  Transparency in model design  Criteria for determining high-value care  Access to high-value providers  Education initiatives beyond the minimum  Ongoing stakeholder engagement

7. © 2016 Medicare Rights Center  Visit us at www.medicarerights.orgwww.medicarerights.org  Call our helpline at 1-800-333-4114  Sign up for Medicare WatchMedicare Watch  Learn on Medicare InteractiveMedicare Interactive  Like us on FacebookFacebook  Follow us at @medicarerights