Help for Payers to Meet VBID Requirements for Medicare Advantage Plans
Many people are taken in by a belief that “you get what you pay for” and that higher price tags tend to be attached to superior products or services. The truth can be significantly more complex. In healthcare, it’s not always the case that increased costs and increased number of services increase quality of care.
Congress created the Center for Medicare & Medicaid Innovation (CMMI) to look at methods of reducing spending for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). However, Congress also expressed that reduced spending couldn’t lower the quality of care offered under those programs. Rather, quality must be maintained or even enhanced.
CMMI is inspiring this level of quality through the emergence of Value-Based Insurance Design (VBID) models, Medicare Advantage plan offerings regulated by CMMI. VBID seeks to increase efficiency by shifting the focus away from quantity of care for Medicare beneficiaries (including dual-eligible beneficiaries) and emphasizing innovation, quality of care and patient choice.
Patients deserve a voice in their care
The importance of member/patient choice and empowerment in healthcare is becoming a vital conversation. Advance care planning (ACP) is a process designed to emphasize and promote patient choice.It puts what the individual values at the center of value based care — likely the reason it is getting increasing attention under VBID requirements.
High-quality digital ACP documents have the ability to clearly communicate patients’ healthcare wishes and be securely and seamlessly retrievable by medical professionals whenever and wherever needed. Use of these documents has demonstrated that spending more does not in fact always achieve desired results. Most patients, when given the option, choose less care. When unwanted end-of-life care is removed, it can result in savings of $14,500+ per patient. Best of all, patients are more likely to receive the level of care they desire.
Navigating VBID requirements with ease
Wellness and health care planning that focuses on ACP requirements is one requirement of VBID plans. These requirements clearly emphasize the important role ACP plays in healthcare. They emphasize outreach strategies, tracking and reporting, as well as safeguards against misuse. While the requirements may initially seem overwhelming, a strategic partner can make this an easy lift. At ADVault, we provide a full suite of tools for VBID plans that allow providers to easily help their members develop advance care plans that will meet those requirements.
Getting the word out
When it comes to understanding and building these kinds of strategies, we’re experts. At ADVault we’ve spent almost 15 years working with payers, providers and policymakers while developing our platform and tools. And, we’ve listened to the consumer to hear what works best for them. This has led us to an understanding of the industry and infrastructure needed that’s both intimate and comprehensive. ADVault offers an award-winning, consumer-facing platform and complete healthcare ecosystem including:
- payer integration tools
- acute and post-acute care provider tools
- home health and hospice clinical tools
- physician practice tools
You can trust in the fact that ADVault possesses the best strategies for offering these services to members — secured by the confidence that ADVault is certified by HITRUST.
An array of options for tracking and reporting
ADVault also makes it much simpler for VBID payers to meet tracking and reporting requirements. VBID plans are required to track each step of the ACP offer process, making the data available for submission to the Centers for Medicare & Medicaid Services (CMS).
The ADVault system tracks:
- account creation
- ACP document updates
- paper uploads
- most current version
- ACP document sharing and viewing
Physician tools also include the ability to track when offers to create an ACP document are declined. Providers can even use easy tool integrations to chart details about how they offered patients access to ACP services. The capability to track data at this level makes meeting VBID requirements intuitive and stress free.
Building toward tomorrow
The CMS and CMMI requirements aren’t going to decrease. The focus on ACP will only intensify as the healthcare environment continues to shift. Technology will play a larger and larger role in the process. And, as NHL star Wayne Gretzky said in an oft-repeated quote, “Skate to where the puck is going, not where it has been.” We’re not interested in chasing after what’s already unfolded within the industry. At ADVault we want to be ready with the tools and systems future generations are going to need.
What that means for our current payer customers is that we’re able to phase them in immediately, as we have technology in place for the entire ecosystem.
COVID-19 and an increasing focus on technology will continue to drive changes in the market. As former governors and former U.S. Secretaries of Health and Human Services, Tommy Thompson and Kathleen Sebelius co-chaired the Aspen Health Strategy Group as it produced its inaugural call to action to the healthcare industry: “Improving Care at the End of Life." The first “big idea” presented was the normalization of ACP, with a callout to CMS, payers, employers, and providers to encourage, incentivize or require the offering of ACP. It appears that CMMI is answering that call.
Patients have to come first
ACP lowers cost by preventing unwanted medical treatments. While older patients and those suffering from chronic illnesses may be the most obvious beneficiaries of ACP, the best way to encourage adoption is to normalize conversations about ACP with patients from all demographics. This allows a wider range of people to take control of their healthcare.
While high-quality ACP can and does cut care costs, that isn’t the primary goal of providing access to plans. Rather, ACP is a tool for member engagement, allowing patients’ desires to be heard. At ADVault, we offer support in framing these conversations, helping develop providers’ internal cultures and showing them how to lead by example.
Compassionate, existing solutions
If payers don’t focus on ACP, then the unfortunate truth is they will continue spending millions of dollars per year paying claims for care their members don’t want. Without a partner like ADVault, payers will also be left to start from scratch, having to figure out solutions for meeting VBID requirements on their own.
If patients’ needs are to come first, then access to an ACP service that meets current VBID requirements is an essential part of their care. Working with a partner like ADVault, with a deep well of knowledge and a focus on the future, can significantly reduce headaches and improve outcomes for everyone involved.
Contact ADVault to discuss ACP solutions for your members.