Advanced Illness Partners (AIP), a joint enterprise established by seven hospice and palliative care providers, will enable its members to provide care further upstream for patients suffering from serious and chronic diseases. The venture was designed to facilitate participation in soon-to-be implemented direct contracting payment models from the U.S. Centers for Medicare & Medicaid Services (CMS).
The direct contracting models, announced in conjunction with the Primary Cares initiative, were initially slated for a Jan. 1 implementation date but were delayed until April 1 due to the coronavirus pandemic. Joining forces allowed the partnership members to meet the program’s requirements regarding the size of a direct contracting entity’s patient population.
“[Direct contracting] is geared towards larger organizations, and it’s harder for smaller providers to be involved,” said Jacqueline Kimmell, director of population health strategy at AIP member Capital Caring Health. “[AIP] allows us to meet that minimum, because we can spread patients out across the country through our different practices.”
The partners in AIP include seven nonprofit organizations: Pure Healthcare, Geriatric Solutions, Hospice of the Valley (Ariz.), Hope Healthcare, Housecall Providers, Cornerstone Hospice, Nathan Adelson Hospice and Capital Caring Health. Pure Healthcare is a venture of Ohio’s Hospice, a group of 10 affiliated providers located throughout that state.
These nonprofit organizations first began connected through participation in the National Partnership for Hospice Innovation (NPHI), according to Kimmell. NPHI is a coalition of non-profit hospices that collaborate on moving innovations forward, in terms of service diversification, discovering new payment models, implementing technologies and efficiencies, and uncovering new approaches to delivering care. Capital Caring Health CEO Tom Koutsoumpas is also president and CEO of NPHI.
The direct contracting options include three voluntary payment models that are designed to help the U.S. Centers for Medicare & Medicaid Services (CMS) and health care providers reduce the cost of care and improve quality. The three models include the professional, global and geographic options.
The models adapt and integrate concepts from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage, as well as strategies used in the private sector.
AIP will be participating in the High Needs Population track of the global direct contracting option, which is designed for Medicare fee-for-service beneficiaries who have complex health care needs.
“We believe this partnership creates a more coordinated format for these organizations to share their strengths in the management of chronic and complex populations,” Anthony Evans, president of AIP member Pure Healthcare, told Hospice News. “The organizations within AIP represent a wonderful diversity in geography, clinical structure, and populations served, and we hope to use this diversity to identify and incorporate best practices at both the process and program level.”
Hospice and other post-acute providers nationwide are working to engage patients further upstream in the course of their illnesses. New avenues of reimbursement are driving service diversification throughout much of the industry, with hospices launching programs like palliative care, PACE, home health and others. This will continue to be a major trend during 2021.
The establishment of AIP will help its founding organizations to develop efficiencies through cost savings and the coordination of resources like telehealth and predictive analytics systems, according to Evans.
“This investment in the tools to effectively manage population risk is something that many health care organizations may not be able to afford on their own,” Evans said. “Collaborations like AIP allow providers to explore new payment models in a more supported, more sustainable way.”
AIP is one of 51 direct contracting entities approved for participation by CMMI. Combined, the seven providers involved in AIP care for more than 60,000 patients annually.
Within the global direct contracting model, providers bear 100% of the risk associated with eligible patients. Contracted agencies would have to choose between a Total Care Capitation option or a Primary Care Capitation option. Similar to the professional direct contracting option, this would be a capitated, risk-adjusted monthly payment for enhanced primary care services equal to 7% of the total cost of care.
“The organizations [participating in AIP] are really excited about the mission of moving more care upstream and providing a full continuum of care to patients,” Kimmell told Hospice News. “All the organizations have their roots in hospice and palliative care, and I think have been seeking for a while to find ways to treat patients earlier in their care journey.