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Multi-Stakeholder Coalition Advocates for HHS to Expand the Scope of Value-Based Insurance Design in Medicare

WASHINGTON, Aug. 21, 2019 /PRNewswire/ -- Today, the Smarter Health Care Coalition, a multi-stakeholder coalition representing consumer organizations, employer groups, health plans, life science companies, provider-related organizations, academic centers, and foundations, advocated for the Secretary of Health and Human Services (HHS) to expand the scope of value-based insurance design (V-BID) in Medicare by permitting CMS more flexibility regarding low-value services.

(PRNewsfoto/Smarter Health Care Coalition)

For more information, please visit www.smarterhc.org.

"The Smarter Health Care Coalition strongly supports any and all efforts to improve the utilization of high-value care, while limiting the use of low-value services that put patients at unnecessary health risks and wastes taxpayer money. We applaud the Administration's efforts to date to expand value-based insurance designs, and we will continue to work with federal policy makers to ensure that Medicare beneficiaries receive high-quality, cost-effective care."    

Also known as "clinical waste," low-value care broadly captures services for which the harms outweigh the benefits. These services often yield marginal patient benefit in comparison to significant medical resource costs and invasive diagnostic procedures. MedPAC has long documented millions of dollars spent on low-value care in traditional Medicare.

Section 4105 of the Patient Protection and Affordable Care Act (ACA) grants the Secretary of HHS the authority to eliminate payment in Medicare for preventive services that fail to achieve an A, B, C, or I designation from the US Preventive Services Task Force (USPSTF). In other words, this authority grants the Secretary power to restrict CMS funding for "D" rated services?which the USPSTF deems as "services that have moderate or high certainty of no net benefit, or that the harms outweigh the benefits." Realizing this authority provides an excellent opportunity to increase the value of Medicare benefits by reducing the utilization of costly services that yield minimal health benefit to the patient.

"The Coalition urges the Secretary to utilize Section 4105 legislative authority and empower value-based insurance designs in Medicare by eliminating payments for D-rated preventive services."

Eliminating Medicare payments for D-rated preventive services would mitigate unnecessary patient out-of-pocket costs and, in some cases, the physical harm associated with these services. Furthermore, the savings associated with the reduction in payments for low-value services would create "headroom" in the Medicare program to focus more resources towards evidence-based, high-value preventive screenings, services, medications, and more.

Katy Spangler
Co-Director, Smarter Health Care Coalition

SOURCE Smarter Health Care Coalition

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