If you plan to enter the value-based insurance design (VBID) market, it’s important to understand the goal of the program in order to make decisions on how to structure it. VBID is a strategy that minimizes or eliminates out-of-pocket costs for high-value services in defined patient populations. Medicare Advantage organization (MAO) must understand the essence of the program and how the plan can help improve enrollee outcomes.
There are minimum requirements that your MAO must implement, as well as optional areas that your plan can choose to implement. Determining which optional components to include will depend on your plan and provider network capabilities. The choices you make are key to the success of your program implementation overall. This can cause some anxiety if there’s little or no experience within your plan in implementing this complex program.
It’s important to start with an understanding of the status of health equity, which CMS defines as the attainment of the highest level of health for all people, starting at the top of the organization. We recommend two important areas of focus:
- Assess staff awareness of health equity
- Develop an employee training program related to health equity
It’s also critical to complete an operational assessment to determine the organization’s current capabilities, including:
- Review current populations and healthcare issues to identify focus areas (member needs assessment)
- Assess capacity and your staff’s ability to support implementation
- Determine the viability of the provider network as it relates to new services
- Assess community resources
- Assess IT capabilities for benefit/services design and capture of data