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New value-based insurance design program

December 1, 2016

Beginning January 1, 2017, Independence will introduce a new voluntary program called the Vital Care Program forKeystone 65 Select HMO and Keystone 65 Preferred HMO members who have been diagnosed with both congestiveheart failure and diabetes.

The Vital Care Program is a Value-Based Insurance Design (VBID) model, which is part of a new initiative that theCenters for Medicare & Medicaid Services is conducting and regulating through the Center for Medicare & MedicaidInnovation. It is designed to help members improve their overall health and well-being and will test whether it canimprove health outcomes and lower expenditures for Medicare Advantage enrollees. Specific to this program is areduced copayment for eligible members when they visit their cardiologist, endocrinologist, or podiatrist. The lowercost-share can help make these visits more affordable, encouraging members to see their specialists more regularlyto help better manage their care.

Under the Vital Care Program, the 2017 reduced copays for specialists? office visits are as follows:

  • Endocrinologist and Cardiologist: $10 copay
  • Podiatrist: $5 copay; $5 copay also applies to both Medicare-covered and six routine podiatry visits per year

Eligible members will be automatically enrolled into the program, but they will have an opportunity to opt out if theychoose to do so. There are no additional participation requirements. Since both Keystone 65 Select HMO andKeystone 65 Preferred HMO are HMO plans, referrals will still be required from the primary care physician for aspecialist visit.

Identifying Vital Care Program members

Eligible members will receive a new ID card that indicates theyare enrolled in the Vital Care Program as well as a writtensummary of benefits (the ?Notice of VBID Benefits?).

The copayment amount for specialists will be listed as ?varies? onthe member?s new ID card as shown. Please be sure to verify themember?s eligibility and benefit information via the NaviNet® webportal at the time of service to ensure the correct copay is beingcollected.

If you have any questions about this program, please contact yourNetwork Coordinator.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.


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