Roughly $345 billion is spent annually on wasteful, low-value health care. The goal of the Value-based Insurance Design (VBID) Model is to reduce this spend while promoting services which offer lasting clinical benefits. The Centers for Medicare and Medicaid Services (CMS) embraced these principles with its calendar year (CY) 2020 VBID application. For the first time, CMS enabled Medicare Advantage (MA) organizations to test whether VBID interventions could reduce overall healthcare spending while improving patient outcomes. 

At its core, VBID does not necessarily aim to eliminate out-of-pocket costs. Rather, the model seeks to align health plan and patient incentives by emphasizing high-value services. 

One of these high-value services is advance care planning. CMS recognized the value of timely, end-of-life conversations by requiring all prospective CY 2020 VBID applicants to provision for ACP through the Wellness and Health Planning (WHP) flexibility. 

Importantly, advance care planning services had to be available for all enrollees. Based on feedback from key stakeholders, CMS retained its advance care planning requirements – once again through the WHP component – for the CY 2022 VBID Model application. 

VBID in a Nutshell

In 2019, the Center for Medicare and Medicaid Innovation (CMMI) created guidelines permitting plans to use VBID in the Medicare Advantage program. Unlike the previous uniformity requirement where health plans could not offer different benefits and cost sharing to beneficiaries enrolled in the same plan, participating health plans in eligible states could now offer reduced cost sharing for high-value services or providers and/or offer supplemental benefits to beneficiaries with specific chronic conditions.

Under CY 2021 guidance, health plans may still require beneficiaries to participate in various care management activities before attaining VBID eligibility. CMS did not provide additional financial incentives to participating health plans.

There are currently four key interventions included in the VBID service delivery model: 

  1. Wellness and Health Care Planning
  2. Interventions based on chronic conditions and/or socioeconomic status (these can include Supplemental Benefits covering new and existing technologies or medical devices
  3. Part C and D Rewards and Incentives Programs
  4. The Medicare Hospice Benefit Component. Applicants interested in the Hospice Benefit Component must apply through a separate CMS RFA

The Mandatory WHP Component

The provision of WHP assesses the impact of timely, coordinated approaches to improving awareness and availability of advance care planning. Because WHP is a mandatory aspect of VBID, Medicare Advantage Organizations (MAOs) must include the following information regarding WHP:

  • The mechanism by which advance care planning will be offered
  • Whether rewards and incentives will be distributed to clinicians and beneficiaries
  • How technology will be used to record and pass along WHP activities

Any MAO’s WHP strategy must anticipate how advance care planning solutions and services will be available to all beneficiaries. Conversations can be conducted telephonically, via video, or in-person.

Advance Care Planning Solutions to Help Achieve WHP

CMS recommends investing in and leveraging digital platforms to support advance care planning. This will help streamline and standardize advance care planning, ensure beneficiaries can make updates, and of course, provide digital access to these care plans.

Vynca offers a number of solutions to effectively offer advance care planning to beneficiaries and track and share advance care planning documents.

Clinician ACP Dashboard – Digital platform for clinicians to streamline all advance care planning. It enables the clinician to guide conversations, digitally document care plans, collect all required signatures electronically, and make these digitally available to clinicians across all care settings.

 Member Engagement Platform – Digital platform to engage members in advance care planning. Members can engage in educational activities, request an advance care planning consult, access existing advance care planning documents, start and/or complete digital documents, and share these documents with loved ones.

 Palliative Care Assessment Tool (PCAT) – A quick assessment tool to identify those beneficiaries who would be appropriate for a palliative care consult.

 ACP Facilitation Services – Trained palliative care clinicians to engage in advance care planning conversations (via telehealth) with beneficiaries and document these conversations.

 Virtual Palliative Care Services – A physician-led, interdisciplinary palliative care team will engage your beneficiaries (via telehealth) who have been identified as appropriate candidates for palliative care.

The Value of Advance Care Planning

Outside of VBID, advance care planning is increasingly being included in value-based payment models, such as the Primary Care First and Radiation Oncology models. Advance care planning is associated with reductions in the overall cost of care at end-of-life, due to reducing hospitalizations and increasing access to palliative care and hospice.

Whether you are currently participating in a value-based care arrangement, or thinking about participating in one in the future, it’s important to start thinking about how you will standardize advance care planning across your population.

About the Author

Alex Paris

Alex Paris is legal intern at Vynca. He is a third year law student at Michigan State University College of Law where he is the Notes Editor of the Law Review.