Humana the Most Prominent Payer in the Medicare Advantage Hospice Carve-In

Among the nine insurance companies that will participate in the Medicare Advantage carve-in during the program’s first year in 2021, Humana, Inc. (NYSE: HUM) operates the most plans that will offer hospice. 

The carve-in, formally known as the hospice component of the value-based insurance design (VBID) model, is designed to assess payer and provider performance within Medicare Advantage. 

The opportunity to engage with patients throughout the health care continuum all the way through end of life as well as the Humana’s interest in its home health and hospice subsidiary Kindred at Home drove the company’s decision to involve its Medicare Advantage plans in the VBID demonstration. 

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”As part of Humana’s ongoing work to grow our presence in the home and improve coordination and seamless care for our members, Humana chose to apply for this demonstration. The Hospice VBID opportunity aligned with both those goals and our involvement with Kindred at Home hospice,” Jim Turner, associate vice president for corporate communications for Humana, told Hospice News. “It is through partnership with them and other hospice providers, existing relationships with palliative care providers and subject matter expertise that Humana is able to begin to carve in hospice through this demonstration. While we believe we bring unique opportunities for both providers and our members. Humana’s year-one engagement is in a targeted number of plans and geographies.”

Humana in July 2018 acquired Kindred Healthcare in partnership with the investment firms TPG Capital and Welsh, Carson, Anderson & Stowe. Humana came away with a 40% stake in Kindred’s hospice, home health and community care business, which now operates as Kindred at Home. The two other investors control Kindred’s acute care and rehabilitation hospitals and other rehabilitation services. 

All told, 53 health plans will offer hospice through the VBID demonstration in 2021, including those affiliated with Humana. These plans cover 8% the market and a limited geographic footprint, according to data from the U.S. Centers for Medicare & Medicaid Services (CMS).

Through Medicare Advantage, CMS contracts with private insurance companies to provide coverage for Medicare beneficiaries. The carve-in, according to CMS, is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians. Reactions to the carve-in demo have been mixed, with many lauding the CMS action and others expressing concern.

CMS has indicated that the full spectrum of services currently offered through the Medicare Hospice Benefit would also be available for patients covered through Medicare Advantage. The agency also indicated that the program would allow for access to palliative care services, transitional concurrent care services, and supplemental benefits to address some social determinants of health. 

Participation in the demonstration is voluntary for both payers and providers. Based on the geographic availability of the 53 participating plans, the program will be available to beneficiaries in 13 states and Puerto Rico.

“A lot of these plans are Humana plans,” Anne Tumlinson, CEO of the consulting firm ATI Advisory, said. “If Humana has a big presence in your market, it’s probably worthwhile to begin to start to develop a relationship with them in the event that this becomes a more national program after the four-year demonstration period.”

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