Health care technology firm Acclivity Health Solutions has designed a program to help hospice and palliative care providers prepare themselves for participation in the Primary Care First Serious Illness Population (SIP) payment model.
The U.S. Centers for Medicare & Medicaid Services (CMS) unveiled the Primary Care First program in April 2019 and plans to implement the models in phases beginning in January 2021, initially in 26 regions throughout the United States. Hospices and palliative care organizations are eligible to participate in the payment models provided they meet the program’s criteria. The program is designed to control costs, reduce avoidable hospitalizations and improve care coordination.
Eligible providers can choose to participate in one or both of two payment options under the program: A general payment option and a Seriously Ill Population payment option designed to serve patients with complex, chronic needs, through which providers focused on caring for that population would receive increased payments.
“Part of what we what we did was to assess the ability for any of these agencies to be able to provide services that were aligned to their mission, but also be able to ensure that the outcome was something that wouldn’t put their agency at risk,” Acclivity CEO Jeremy Powell said. “Primary care, hospice, palliative care, homebound primary care, those are on the provider side, and then we have helped a number of health plans or organizations who are going to become health plans also participate either in SIP or the direct contracting entity.”
Medicare beneficiaries with advanced illness, defined as late-stage chronic illness that threatens health and the patient’s ability to function, represent 4% of Medicare beneficiaries but account for 25% of its costs, according to a Sutter Health study. These patients, who often reach a point where treatments begin to lose their impact, frequently experience avoidable hospitalizations close to the end of life.
The Serious Illness Population model is designed to control costs, reduce avoidable hospitalizations and improve care coordination for that population.
Acclivity Health has designed educational programming and other services intended to help not only providers prepare to apply and participate in the model, but health plans as well.
“What we do and what other population health companies do with data is a whole host of analysis and insights that we predict. So our cohort is going to come through this with us. They’ll know the palliative performance scale of these patients; they’ll know patients’ mortality predictions; they’ll know the likelihood of [hospital] admission. They’ll know frailty, and whether patients are able to age in place and remain independent. It’s the first time that hospices are really going to get that data on their own for patients under their care, which is going to be game changing.”
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