Key Takeaways
- 62 Medicare Advantage Organizations are participating in the VBID Model for CY 2025.
- The model will be tested through 967 plan benefit packages across 48 states, D.C., and Puerto Rico.
- MAOs must address health-related social needs and target benefits to underserved areas.
- Enhanced reporting and new benefit requirements are introduced to improve healthcare quality.
The Centers for Medicare & Medicaid Services (CMS) has announced the participating Medicare Advantage Organizations (MAOs) for the Calendar Year (CY) 2025 in the Value-Based Insurance Design (VBID) Model, aiming to enhance healthcare quality and address health inequities. This initiative involves 62 Medicare Advantage Organizations across 48 states, the District of Columbia, and Puerto Rico, offering nearly 1,000 different plan benefit packages.
These participants will implement Health Equity Plans to tackle disparities in healthcare access and outcomes, introducing enhanced reporting and benefits to meet enrollees’ health-related social needs. The model not only focuses on improving healthcare delivery but also addresses broader social determinants of health (SDOH) that influence patients’ well-being, particularly in underserved communities.
For the upcoming year, the VBID Model will see significant participation, with 62 Medicare Advantage Organizations testing the model through 967 plan benefit packages. This broad participation span covers almost the entire United States and its territories, including Washington D.C. and Puerto Rico. Each Medicare Advantage Organizations has prepared specific Health Equity Plans, outlining strategies to address inequities and disparities in healthcare access and outcomes, ensuring all enrollees receive quality care.
Enhancing Healthcare Equity: VBID Model’s Focus on Social Determinants and Underserved Communities
The model’s requirements include offering benefits that address enrollees’ health-related social needs (HRSNs), such as access to nutritious food, housing stability, and transportation, focusing particularly on those in underserved areas. By prioritizing these social factors, CMS aims to provide more holistic care that goes beyond traditional medical services.
All participating Medicare Advantage Organizations are committed to addressing potential inequities and disparities in care access and outcomes. For CY 2025, the VBID Model introduces mandatory Health Equity Plans and additional reporting requirements. These plans target underserved populations, particularly those in areas identified by the Area Deprivation Index (ADI), a tool that helps identify regions with significant social and economic challenges.
The model’s focus on addressing HRSNs through tailored supplemental benefits ensures that healthcare services are equitable and cater to the unique needs of diverse populations, including low-income individuals, racial and ethnic minorities, and those living in rural or underserved areas. This comprehensive approach is designed to reduce barriers to care and improve overall health outcomes.
Medicare Advantage Organizations Drive VBID Model Evolution for Enhanced Equity and Cost Efficiency in 2025
The VBID Model has evolved significantly since its inception in 2017. Initially, the model tested whether flexible coverage and payment options could reduce Medicare costs and improve care quality. Over the years, CMS has introduced various changes to the model, expanding its scope and incorporating new components like the Hospice Benefit and Health Equity Incubation Program.
For CY 2025, CMS has made further adjustments, including the discontinuation of certain components and the addition of new requirements to better meet statutory goals. By focusing on improving equity, these updates ensure that the VBID Model continues to evolve in alignment with emerging healthcare needs and priorities, offering more inclusive and efficient care delivery.
The ongoing adjustments to the VBID Model reflect CMS’s commitment to modernizing the Medicare Advantage program. By continuously testing and refining the model, CMS aims to find the most effective strategies to reduce costs and enhance care quality. The focus on health equity and addressing social determinants of health highlights the importance of comprehensive care that considers all aspects of an individual’s well-being. As the model progresses, CMS will continue to monitor and report on its impacts, ensuring that the lessons learned contribute to the overall improvement of the Medicare Advantage program, while making healthcare more accessible and equitable for all beneficiaries, particularly the most vulnerable.
Resource: Centers for Medicare & Medicaid Services, September 27, 2024
This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.
