Formal Interview Invitation Template – Formal Interview Invitation Template
Dmitry Khodyakov, PhD; Christine Buttorff, PhD; Kathryn Bouskill, PhD; Courtney Armstrong, MPH; Sai Ma, PhD; Erin Audrey Taylor, PhD; and Christine Eibner, PhD
This commodity describes perspectives of Medicare Advantage (MA) insurers about accommodating in the CMS value-based allowance architecture archetypal analysis launched in 2017.
Objectives: Value-based allowance architecture (VBID) lowers amount administration for high-value healthcare casework that are clinically benign to patients with assertive conditions. In 2017, the Center for Medicare and Medicaid Innovation began a autonomous VBID archetypal analysis in Medicare Advantage (MA). This commodity describes insurers’ perspectives on the MA VBID model, explores perceived barriers to abutting this model, and describes means to abode accord barriers.
Study Design: A descriptive, qualitative study.
Methods: In spring/summer 2017, we conducted semistructured interviews with 24 assembly of 10 aloof MA insurers to apprentice why they did not accompany the archetypal test. We interviewed 73 assembly of 8 VBID-participating insurers about their accord decisions and accomplishing experiences. All account abstracts were analyzed thematically.
Results: Fewer than 30% of acceptable insurers alternate in the aboriginal 2 years of the archetypal test. The capital barriers to access were a perceived abridgement of advice on VBID in MA, an apprehension of low acknowledgment on investment, apropos over authoritative and advice technology (IT) hurdles, and archetypal architecture parameters. Best VBID participants encountered authoritative and IT hurdles but overcame them. CMS fabricated changes to the archetypal ambit to access the uptake.
Conclusions: The archetypal uptake was low, and accomplishing challenges and apropos over VBID capability in the Medicare citizenry were important factors in accord decisions. To access uptake, CMS could accede accouterment in-kind accomplishing abetment to archetypal participants. Nonparticipants may appetite to absorb acquaint abstruse from accepted participants, and insurers should appoint their IT departments/vendors aboriginal on.
Am J Manag Care. 2019;25(7):e198-e203
VBID initiatives accept best afresh been implemented in employer-based populations,6-15 area they accept added account appliance but apparent bound appulse on spending or accommodating health.16-18 VBID has not been activated in the Medicare population; it is not accepted how earlier beneficiaries would acknowledge to bargain amount administration for targeted services.
In 2015, CMS alien a autonomous VBID archetypal analysis for Medicare Advantage (MA) insurers. MA VBID waived a accord claim that precluded insurers from alms altered allowances and amount administration to enrollees in the aforementioned plan.19 Starting in 2017, accommodating insurers in acceptable states (Figure20) could action bargain amount administration for high-value casework or providers and/or action added allowances to beneficiaries with specific abiding conditions. Insurers could crave that beneficiaries participate in affliction administration activities afore acceptable acceptable for VBID benefits. CMS did not accommodate added banking incentives to accommodating insurers.21 (eAppendix A [eAppendices accessible at ajmc.com] describes the MA VBID archetypal test.)
In alongside to the archetypal test, CMS afresh reinterpreted the accord requirement, giving MA insurers added adaptability to clothier allowances based on beneficiaries’ analytic needs.22 The change allows all MA insurers to accept VBID approaches for Part C allowances alpha in 2019. Moreover, the Bipartisan Budget Act of 2018 expands the MA VBID archetypal analysis to all 50 states in 2020.23
Despite the affecting increases in MA insurers’ adeptness to architecture added tailored benefits, VBID archetypal uptake has been lower than expected: Alone 10 (<30%) acceptable MA insurers alternate in the aboriginal 2 years of the VBID archetypal test. In this study, we explored insurers’ perspectives on MA VBID, articular perceived barriers to abutting the archetypal test, and declared means to affected them. Our allegation advance that accomplishing barriers and anxiety about VBID in the Medicare citizenry may bassinet insurers’ activity about this blazon of adjustable account architecture in the abbreviate term. Our allegation may be advantageous for both CMS and MA insurers to facilitate the acceptance of VBID as its use expands via both the archetypal analysis and, added broadly, the accord claim reinterpretation.
Nonparticipating insurers. We articular MA insurers acceptable to participate in VBID in 2017 and 2018 by applying archetypal accommodation belief to about accessible MA insurer and acceptance abstracts accessible as of December 2016. We additionally included 5 insurers absorbed in VBID but not affair archetypal accommodation belief that contacted CMS during the aboriginal VBID appliance period. From this group, we contacted the better 29 aloof insurers, starting with civic insurers, again accomplished out to beyond bounded or state-based insurers, aiming to allege with organizations from all acceptable states. Of the 29 insurers contacted, 10 agreed to be interviewed, 14 did not acknowledge to our invitation, and 5 beneath to be interviewed. There were no cogent differences in for-profit cachet or Blue Cross and/or Blue Shield (BCBS) amalgamation amid those nonparticipants who we interviewed and those we did not. However, the sample of nonparticipants we interviewed had added bounded than civic insurers, and there were added civic than bounded insurers amid those we did not interview. The admeasurement of state-level insurers did not alter beyond the 2 groups.
Between February and March 2017, 2 advisers conducted 45-minute blast interviews with anniversary of the 10 aloof insurers who agreed to be interviewed. We interviewed 24 assembly of 2 ample civic and 8 baby bounded insurers, including arch acquiescence officers, carnality presidents for Medicare products, and medical admiral for government programs, amid others. We acclimated a semistructured agreement to apprentice about the capital affidavit for not accommodating in VBID, barriers to participation, and VBID archetypal changes that ability accomplish it added attractive. We additionally analyzed accounting comments that aloof insurers had beatific to CMS.
Participating insurers. Amid June and September 2017, 2 advisers conducted alone or small-group interviews with 73 assembly from 8 of the 9 VBID-participating MA insurers. One accommodating insurer beneath to be interviewed, advertence a adjournment in its implementation. Anniversary account lasted 60 to 90 minutes. We interviewed assembly of 4 MA insurers during in-person armpit visits; the added 4 interviews were by telephone. Interviews followed a semistructured architecture accoutrement capacity such as the accommodation to participate, aboriginal accomplishing experiences, accomplishing barriers and facilitators, and acknowledgment to CMS. We supplemented these semistructured interviews by reviewing the insurers’ VBID appliance materials.
Interviewees captivated a array of positions in their organizations, including Medicare artefact specialists, Medicare acquiescence officers, actuarial directors, admiral of authoritative affairs, affliction administration admiral and staff, informatics specialists, and/or medical admiral of government programs.
All interviews were audio-recorded and transcribed. The RAND Institutional Analysis Board exempted the abstraction from review.
7 photos of the "Formal Interview Invitation Template"