A forthcoming hospice carve-in for Medicare Advantage plans will help provide seamless transitions to hospice from other care settings such as home health care or hospitals, according to Humana’s (NYSE: HUM) recently appointed Chief Medical Officer William Shrank, M.D.
The U.S. Centers for Medicare & Medicaid Services (CMS) will begin testing the hospice carve-in in 2021. Through Medicare Advantage, CMS contracts with private insurance companies to cover Medicare beneficiaries. Nearly 40% of Medicare beneficiaries are currently enrolled in Medicare Advantage plans.
“Right now, there’s this forced choice. You can either say, ‘I’m getting curative treatment,’ or, ‘I’m getting palliative treatment.’ Then the payment for that treatment comes from different sources,” Shrank told Hospice News’ sister publication Home Health Care News. “That forced choice delays care and creates a great deal of anxiety around helping patients with advanced illness manage their symptoms. The idea is that, if you can carve in hospice, you can have more seamless transitions.”
A transition of care involves the transfer of a patient from one care setting to another, such as a hospital discharging a patient who is entering hospice. Care transitions are a risky time for patients, increasing the risk of adverse events due to disruptions in care coordination and potential communication deficiencies, according to the U.S. Agency for Healthcare Research & Quality.
A 2013 white paper by health care accreditor The Joint Commission indicated that transitions from a hospital to the home setting, where most patients receive hospice care, tend to be the most problematic.
Insurance giant Humana is working to bridge the gap between payers and providers. In 2018 the company in partnership with private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe closed a $4.1 billion acquisition of Kindred Healthcare, one of the largest hospice providers in the country. Kindred is also a large provider of home health care and operates 75 acute-care hospitals and 19 rehabilitation hospitals.
On the heels of the Kindred transaction, Humana and the same private equity partners went on to acquire North Carolina-based Curo Health Services for $1.4 billion.
Breaking the firewall between payor and provider also helps support seamless patient transitions, according to Shrank.
“You don’t go through the inconvenience of having to change payers,” Shrank said. “But more importantly, you don’t have the issue of having to change providers because of networks and other things. Also, you’re not forced to make these decisions and feel like you’re giving something up.”
Integrating Kindred and Curo into Humana’s systems is a top priority for the company, Shrank indicated, including integration of data, software platforms, and ultimately team coordination.
“It’s one of the places we’re investing our most resources. It’s the integration that’s going to be the difference. Owning a bunch of different components but having them operate as silos is not that helpful,” he said. “Breaking down silos and making sure there’s integration is critical for changing the way in which we care for people in the home. Medicare Advantage is uniquely positioned to be able to support this.”