Leveraging quality data and education when establishing payer relationships will be critical to success as hospices begin to work within the value-based insurance design (VBID) demonstration, often called the Medicare Advantage hospice carve-in. The program started small in its first year, with 53 participating health plans, but stakeholders expect it to grow in 2022 and 2023. Data will play a key role for providers to help payers connect the dots between cost savings and hospice care.
The demonstration is intended to increase access to hospice services and facilitate better care coordination, according to 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 VBID demonstration launched Jan. 1.
Hospices faced strong headwinds during the COVID-19 pandemic. The outbreak complicated providers’ ability to prepare for the carve-in, according to Bethany Snider, M.D., senior vice president and chief medical officer of Hosparus Health, a hospice and palliative care provider serving nearly 9,000 patients and their families in Kentucky and Indiana. Nevertheless CMS launched the program as scheduled.
“Hospice has been very insulated. It’s at a very small level outside of Medicare. Many thought VBID would get pushed off, and then the pandemic showed up,” Snider told Hospice News during the Home Health Care News Medicare Advantage summit. “This is still the future, and I hope more payers get into it and reach out to partners and providers like hospices to help do this work together. Part of the demonstration is to figure out what is the best way to administer the hospice benefit in a different way, and hopefully establish a palliative care benefit and payment structure. This is where innovation occurs.”
A growing number of hospices have been diversifying their services to engage patients further upstream, with palliative care a leading avenue. The carve-in is among the value-based models that could promote an established palliative care benefit.
Humana (NYSE: HUM) operates the highest number of Medicare Advantage plans offering hospice through the carve-in, 10 of the 53 participating plans. These plans currently cover 145,000 patients. Hosparus is a member of Humana’s preferred provider network for VBID.
“We were excited to see the hospice carve-in benefit, and we made the decision early on to participate. The pandemic had a dampening effect on smaller plans that didn’t already have the infrastructure in place to participate in year one,” Kirk Allen, senior vice president of home care for Humana, said. “We maintained the momentum, and our team had built the system to go full forward with our plans. It’s given us early insight into the innovation, and I do think others will follow.”
Hospice and palliative providers need to be ready to educate payers about the value of their services to patients and their families. Hospices need to have the data to demonstrate that they can offer high quality and lower cost of care, particularly when it comes to a provider’s track record with reducing hospitalizations, readmissions and emergency department visits, according to Snider.
“It’s best to be at the forefront, because then you have influence,” Snider said. “Use [data] as an opportunity to educate payers on the great work that you’ve done, the value that you bring, and then to advocate for what you believe this type of care should look like,” Snider said. “Just like when we talk to patients about their goals and what’s important to them, start at the beginning [with payers]. Make sure we’re all on the same page about the high value hospice can add.”
The ability to show cost savings and positive clinical outcomes is essential to getting a seat at the table in Medicare Advantage, Snider told Hospice News.
Payers will be keeping a close eye on quality scores and patient outcomes as the carve-in continues to take shape.
“We’re looking for high quality providers in terms of how they help performers score out on the current [Hospice Item Set] scores as an indication of their commitment towards being a well-run entity,” said Allen. “We’re looking for a total cost of care mindset when it comes to a hospice and palliative program. It’s definitely leg up for a provider if they have a mature palliative program coupled with their hospice offering, because they can offer more of a seamless service.”