Data Analytics Give Hospice an Edge in Value-Based Care

Hospice providers are increasingly turning to data analytics systems to gain an edge against competitors when engaging prospective referral partners, anticipating impacts in value-based care. Data are key to demonstrating the value of hospice to potential referral partners as evolving value-based payment models take effect.

The value-based insurance design demonstration project, commonly called the Medicare Advantage hospice carve-in, began at the start of this year, and providers in markets where the program is operating have been working to adapt to this new payment environment. Data analysis and management is important for hospices to expand referral networks, and providers are applying machine learning tools to identify patients in need of their services earlier in the course of their illnesses and track outcomes. Machine learning is a form of artificial intelligence that uses algorithms and statistical models to detect patterns in data and make predictions based on those patterns.

Patient data are often extracted from electronic health records or insurance claims. Hospices can leverage baseline patient information to determine which referral relationships can be strengthened, according to Kassie Hodge, director of hospice and palliative care at Mosaic Life Care Health Systems.

“Data are going to help us figure out which of our physicians are really giving us the referrals, and who is waiting too late for them. That’s an important thing as we look at inpatient populations and as those rules change for Medicare and where we are at in that care continuum,” said Hodge during a recent Hospice News webinar. “If we don’t have a good baseline, then that was a lot of manual hours spent digging up a ton of data that are right there in front of you.”

Headquartered in Missouri, Mosaic has an average daily hospice census of 140 to 150 patients and cares for around 240 home health patients per month, according to Hodge. Missouri hovered just above the national average of hospice utilization among Medicare decedents in 2018 at 50.2%, according to the National Hospice and Palliative Care Organization (NHPCO).

Among Medicare Advantage plans, 53 will be covering hospice in 2021 through the value-based insurance design (VBID) model in 13 states and Puerto Rico, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Medicare Advantage is seeing record-high levels of participation for 2021 among beneficiaries, reaching about 42% for 2021, CMS reported.

Mosaic operates in three states: Missouri, Kansas and Iowa. No Medicare Advantage plans in those regions are currently offering hospice through VBID, but the program is expected to expand to more markets as the demonstration progresses. Many stakeholders believe that the future of hospice will be entwined with value-based payment in coming years and are preparing for Medicare Advantage even if they are not able to participate this year.

Having a grasp on health data around patient populations will put hospices ahead of the game against competitors as they view new referral streams, according to Hodges.

“Data is really going to bring our hospice, and even our home health, ahead of the game in our area because we’re going to know real-time where our market share is. We’re going to know what our quality measures are,” said Hodge. “Keeping our eye on the market share is very important, because that’s really what helps drive our organization to prove ourselves. We’re looking at where we are compared to our partners, and how we can become the best in our area and region.”

Clinical and financial analytics can give hospices a competitive advantage, according to Deborah Wesley, CEO of Addison County Home Health and Hospice. Based in New Haven, Vt., Addison’s daily census averages between 450 and 500 patients, including both home health and hospice. Analytics are critical for hospices to connect with referral sources sooner and move patients throughout the continuum in value-based care.

“The mix we have in our home health or hospice, our Medicaid waiver program, our private duty and growing into some physical therapy is well-blended. Analytics are critical for us because it helps us move patients through our continuum,” said Wesley during the webinar. “We have patients that can be in different business units at the same time, and we need to know when to move them from home health or palliative, the hospice, when they’re on waivers. ”

Hospice utilization in Vermont reached 42.9% among Medicare decedents in 2019. The state’s utilization rate saw a 22.26% jump between 2014 and 2018, representing the largest increase in hospice utilization nationwide during that period, according to NHPCO.

Even though VBID has not yet hit Vermont, the hospice and home health provider is “getting out in front of it” and using data to inform their business decisions in anticipation of payment changes, according to Wesley. She added that hospices planning to participate will need to get their electronic health record systems up to speed to avoid falling behind in attracting referral interest against competitors.

“If you don’t have great data tools, great plans to get that data and someone to help you with it, then you’re going to get lost. In value-based programs, data turns into cash and you need to get out in front of it,” said Wesley. “When you can talk to your staff and your referral sources and say here’s the data from this week and this day, it’s a game changer. Being able to look at referral sources, length of stay and drilling it down to individual physicians and practices helps us to understand which referral sources we need to talk to about early referral.”