Hospices need to take a sharp look at their quality indicators to successfully work with Medicare Advantage Plans. Efforts to boost Hospice Compare star ratings and patient and family satisfaction scores will be essential when the hospice demonstration of the value-based insurance design model begins in 2021, often referred to as the Medicare Advantage hospice carve-in. 

This according to SCAN Health Plan CEO Sachin Jain, M.D., who spoke at Hospice News Virtual Summit on Value-Based Care Strategies for Hospice and Palliative Care. SCAN Health Plan, a nonprofit Medicare Advantage plan, covers more than 220,000 beneficiaries. The plan expects to participate in the carve-in beginning in 2022, Jain told Hospice News.

“Star ratings are not just consumer facing measures — although that’s how a lot of Medicare Advantage plans use them — they also dictate your revenue. If you have a large Medicare Advantage book like we do, the change between a four-and-a-half star rating and a four-star rating actually quantifies in the tens of millions of dollars,” Jain said at the Summit. “I would familiarize yourself with the things that are important to [a Medicare Advantage plan] as a customer of your services on behalf of the members we serve and frame a lot of what you do in that language. I think organizations that invest the effort to understand their customer in that way will actually do quite well in this new world.”

Among the most important sources of data is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, according to Jain.

For hospice, CAHPS surveys are sent to the family after the patient has passed away to gauge their satisfaction with the care their family member received. The survey vendor contacts the family by phone or mail approximately 42 days after the end of the month in which the patient died.

The survey’s 47 questions indicate the family’s perception of hospice performance on 11 metrics such as hospice team communication, symptom management, emotional and spiritual support, patient and caregiver training, and whether the family would recommend the hospice, among other data points.

“Medicare Advantage plans are actually measured along a number of dimensions that will then become a part of how hospice organizations are measured. One of them is CAHPS scores,” Jain said. “The most important thing we care about is the patient experience and that sense of care coordination. Become very familiar with the cap survey, which is a survey that’s administered to patients annually. Understanding how Medicare Advantage plans are measured and paid by regulators, star ratings, and CAHPS scores is going to be very significant.”