Hospices Leverage Palliative Services in VBID Arena

Hospice providers are increasingly expanding palliative services as a bridge to end-of-life care and engage patients further upstream. With the forthcoming value-based insurance design (VBID) demonstration, hospices that have robust palliative care business lines will have a leg up on competitors in demonstrating their value to participating insurance plans.

Many hospice providers see palliative care as essential to participating in the VBID demonstration project starting in 2021, commonly called the Medicare Advantage hospice carve-in. Palliative care is among the requirements of participation, drawing insurance payer interest in hospices featuring these services.

“Through the demo it is a requirement to offer greater palliative services that might exist today,” said Susan Diamond, segment president of home solutions for Humana (NYSE: HUM). “The demo gives us the ability to provide additional support mechanisms for patients to really understand where the deficiencies in what hospices can do today, and where the opportunities are. Things like additional transitional care services, more robust palliative services before someone becomes eligible for hospice, greater continuity of care and smoother transitions, and greater coordination for the provider are all things that we think can be accomplished through the demo. It will eliminate some of the hard, sort of bright-line handoffs that occur today.”


Diamond recently spoke at Future, a event by Hospice News sister site, Home Health Care News. Humana is one of two large insurance companies participating in the VBID model, with the most Medicare Advantage plans offering hospice in 2021. Nine insurance companies currently operate the 53 participating plans as the hospice carve-in starts small, with additional growth anticipated throughout the four-year VBID demonstration.

The Medicare Advantage hospice carve-in allows for insurance coverage of certain supplemental benefits such as palliative care.

According to Diamond, Humana will participate in the demonstration project on roughly 10 plans with the intent of scaling more broadly longer term, identifying “a number of top partners” in the hospice space as potential growth.


“Our hope is that through the demo we can create high-quality hospice partners who can build out those high-quality palliative programs,” said Diamond. “We intend to make available true, comprehensive palliative services for patients, creating a much smoother transition through the end of life. We can work with our physician partners to better understand those offerings and then, if appropriate, have the competence to make the needed transition into those services, which we have found is difficult and happens far too infrequently today.”

Focusing on building up hospice services was part of the insurance company’s efforts to expand health care offerings in home settings during 2020.

With improved care coordination and transitions of care part of the value-based insurance design, getting further upstream in patients’ illness trajectories through palliative care programming has been among the strategies hospices are employing to participate in the coming value-based payment environment.

“Hospice companies are really well-positioned to deliver palliative services,” Diamond remarked. “There are some other companies who tried to do that on a standalone basis, and they certainly fill a need that exists today. I think it falls short of the comprehensive needs that there are. We need to leverage those hospice partners to build out more robust palliative offerings.”

Companies featured in this article: