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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 for Keystone 65 Select HMO and Keystone 65 Preferred HMO members who have been diagnosed with both congestive heart failure and diabetes.

The Vital Care Program is a Value-Based Insurance Design (VBID) model, which is part of a new initiative that the Centers for Medicare & Medicaid Services is conducting and regulating through the Center for Medicare & Medicaid Innovation. It is designed to help members improve their overall health and well-being and will test whether it can improve health outcomes and lower expenditures for Medicare Advantage enrollees. Specific to this program is a reduced copayment for eligible members when they visit their cardiologist, endocrinologist, or podiatrist. The lower cost-share can help make these visits more affordable, encouraging members to see their specialists more regularly to 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 they choose to do so. There are no additional participation requirements. Since both Keystone 65 Select HMO and Keystone 65 Preferred HMO are HMO plans, referrals will still be required from the primary care physician for a specialist visit.

Identifying Vital Care Program members

Eligible members will receive a new ID card that indicates they are enrolled in the Vital Care Program as well as a written summary of benefits (the “Notice of VBID Benefits”).

The copayment amount for specialists will be listed as “varies” on the member’s new ID card as shown. Please be sure to verify the member’s eligibility and benefit information via the NaviNet® web portal at the time of service to ensure the correct copay is being collected.

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

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

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