Wakely Finds VBID Sunset Could Impact Medication Adherence Rates
Many Medicare Advantage (MA) proponents have said that the sunset of the Value Based Insurance Design (VBID) in Medicare Advantage (MA) as of 2026 could have impact on outcomes and complicate affordability of healthcare for beneficiaries. Wakely Consulting, an actuarial and consulting firm, has found that this could be true in the area of medication adherence.
Plans have used the VBID program to target waiver of pharmacy cost-sharing for low-income (LI) beneficiaries. These are the same targeted individuals in the new Health Equity Index (HEI) rolling out in Star Year 2027. Wakely found that medication adherence for diabetes, hypertension, and hyperlipidemia could be impacted if the cost-sharing waivers disappear. The analysis found that removing copays on maintenance medications improved beneficiary adherence, which is tied to improved quality of care and health outcomes. These are three key star measures in the Part D program. Wakely argues eliminating copays for this LI group needs to remain a focus after the VBID sunset.
Wakely found that in the first year of waiving LI cost sharing, every plan demonstrated improvement in at least one medication adherence measure. Five out of the eight plans observed improvements in all three adherence measures. Two others showed progress in two of the measures, while the remaining plan improved in just one measure. Wakley says that eliminating copay barriers for LI individuals enhances their ability and willingness to consistently fill their prescribed medications.
The normalized improvement observed in medication adherence was significant in all three measures: 2.2% improvement for diabetes, 2.5% improvement for hypertension, and 1.2% for cholesterol.
#cms #stars #vbid #medicationadherence #quality
Emerging Fight Over Impoundment Authority Of President
Republicans are proposing changes to the Impoundment Control Act of 1974 that they say limits the president’s authority to withhold appropriations. The Congress Budget Office (CBO) says the act and process established actually allowed impoundment with congressional consent. It says repealing the process will not mean far-ranging authority for the president. Courts seem to have sided with Congress in that Richard Nixon did not have the far-reaching authority to withhold funds.
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#trump #healthcare #spending
https://insidehealthpolicy.com/daily-news/bill-would-let-trump-opt-out-spending-appropriated-funds
A Bit Of A Mixed Outlook On Digital Health
Many investors, entrepreneurs, and digital health enthusiasts are breathing a bit of a sigh of relief as the digital health market normalized after a steady decrease in 2022 and 2023. Funding remained constant throughout the year, according to research firm Rock Health. Interest in artificial intelligence (AI) has helped venture capital funding in digital health.
But experts predict a mixed outlook and a relatively soft market. They say a focus on core problems and the right use cases, especially with AI, are critical.
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#digitalhealth #ai #healthcare
https://www.modernhealthcare.com/digital-health/venture-capital-predictions-2025-ai-trends
Outgoing Healthcare Exec Shares Views on Future Of Healthcare
Outgoing CEO of LA Care Health Plan, John Baackes, shared his views on the future of healthcare with the incoming Trump administration taking office soon. It is a far-reaching interview with Modern Healthcare.
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#healthcare #trump #medicare #medicaid #exchanges
— Marc S. Ryan
