For decades, U.S. policymakers have been working to stop the nearly steady increase in healthcare costs while improving health outcomes and offering more person-centered care. America has higher per-capita healthcare spending than any other high-income country in the world, and we score worst among those nations on multiple health benchmarks, including life expectancy and avoidable deaths.
In the Medicare Advantage (MA) space, one effort to reduce these trends is Value-Based Insurance Design (VBID). In this model, MA health plans offer lower cost sharing for “high value” services and medications, or those services that have been shown to result in better health outcomes for particular people. Today, VBID plans also offer expanded access to supplemental benefits such as non-emergency medical transportation and nutrition assistance that can have a measurable impact on member health.
As Medicare Advantage enrollment expands, so has VBID: In 2024, according to the Centers for Medicare and Medicaid Services (CMS), 69 participating Medicare Advantage Organizations (MAO) offered a VBID model, compared to just nine in 2017, with a projected 12.4 million people currently enrolled in those plans. That’s a significant percentage of the 30.8 million people enrolled in MA in 2023, or 51% of the eligible Medicare population. MA plans are popular because they offer expanded benefits and, often, better health outcomes than traditional Medicare, including lower hospitalization rates, fewer hospital readmissions, better medication adherence, and better scores on 10 out of 11 preventative measures. Additionally, 88% of available dual-eligible special needs plans (D-SNPs) will participate in VBID in 2024.
How Does VBID Improve Person-Centered Care?
The CMS Innovation Center introduced the VBID model in January 2017 as a test to see if it could lower Medicare spending and improve outcomes; it is scheduled to run through January 2030. VBID reduces consumer cost sharing for certain high-value services or benefits, depending on that person’s unique circumstances.
VBID for MA was first launched in seven states and applied to MA enrollees who fell into certain clinical categories: diabetes, congestive heart failure, chronic obstructive pulmonary disease, hypertension, past stroke, mood disorders, or a combination of those diagnoses. CMS said MAOs could design their own VBID plans, but benefit changes had to fall into four categories:
- Reduced cost sharing for high-value services
- Reduced cost-sharing for high-value providers
- Reduced cost-sharing for disease management or related programs
- Clinically targeted supplemental benefits
VBID has been structured to encourage MA health plan members to use the services that benefit them the most, with the definition of “high-value services” dependent on their unique situation.
Today, VBID also gives MAOs the flexibility to ensure that targeted members get the care and support they need based on chronic health condition, socioeconomic status, or if they live in an underserved location. For example, “under this model, participating MA plans may provide patients with tailored supplemental benefits like lower costs for prescription drugs; grocery assistance to help ensure their unmet medical and nutrition needs are met; transportation services to make sure they can attend medical appointments; and support managing chronic health conditions.”
Starting in 2025, as part of their VBID plans, MAOs will be required to offer supplemental benefits to address health-related social needs in two of three areas: food, transportation, or housing insecurity. How do these supplemental benefits improve health outcomes?
- Transportation: A 2022 review of scientific literature found that insufficient access to non-emergency medical transportation (NEMT) leads to missed or delayed care in up to 3.6 million people each year, and NEMT barriers may be to blame for at least a quarter of missed clinic appointments.
- Housing: Research has shown strong links between chronic health conditions and housing insecurity. A study of newly homeless people in New York City shelters found that 53 percent had a substance use disorder, 35 percent had major depression, 17 percent had asthma, 17 percent had hypertension, and 6 percent had diabetes—all rates significantly higher than the general population.
- Nutrition: Evidence shows that a healthy diet is associated with better outcomes for cardiovascular disease, obesity, type 2 diabetes, bone health, and certain types of cancer—and a lower risk of death from any cause.
What About Medicare Advantage Star Ratings?
Whether a Medicare Advantage plan integrates value-based insurance design or not, it is still subject to the same Star Ratings as any other MA plan. A review of VBID performance between 2020 and 2022 found that VBID General was associated with a 0.31-point or 8% improvement in their 2023 Star Ratings, which used measurement data from 2021.
The review also found that in 2020, MA members in VBID General plans had small increases in prescription medication adherence—as well as a 6.8% increase in risk scores, which reflect expected medical spending based on a member’s health conditions. The CMS report theorized that because VBID aims to increase visits with care providers, it could result in more or earlier diagnoses for those members, driving up their risk scores. The agency also reported an 11.9% increase in inpatient stays, which “could reflect latent need for hospital-based treatments or other delayed care that is discovered through increased interactions with providers.” CMS said it would be important to revisit these metrics as more updated data is available.
How SafeRide Health Fits into the VBID Model
The goal of VBID is to lower Medicare spending while improving health outcomes, and as an industry-leading NEMT broker, SafeRide helps health plans achieve both of those goals for traditional MA plans and VBID MA plans. Our technology-first approach improves the member experience; drives efficiency; lowers healthcare and operational costs; combats fraud, waste, and abuse; and can lead to better Star Ratings. We track and share countless data points on every ride, so health plans know how many rides are fulfilled and understand how well they are fulfilled.
SafeRide has created a seamless, nationwide network that serves as a vital lifeline to care—and can even prolong a member’s life. In fact, 65% of all our trips are to life-sustaining care across rural and urban patient populations, and those riders are given an extra level of support from multiple SafeRide teams.
We work around the clock to confirm every ride and connect with our transportation providers and members to ensure we are providing the highest level of service. SafeRide’s industry leadership is reflected in transportation performance metrics—fulfillment, call center, grievance, etc.—that exceed industry averages and reflect our commitment to serving members in the best and most efficient way possible.
Transportation is a crucial link connecting millions of people to the care that keeps them healthier: A recent CDC survey reported that 5.7% of adults in the U.S. don’t have access to reliable transportation. SafeRide is a natural partner for MA plans to ensure that each patient gets the right care at the right time.