Center for Medicare Director Touts Palliative Care’s Holistic Approach, Hints at Value-Based Care Plans

Health care policymakers continue to focus on “co-creating the future of Medicare” as the nation emerges from the COVID-19 pandemic. Dr. Meena Seshamani is leading that charge within the U.S. Centers for Medicare & Medicaid Services (CMS) – and she’s doing so by leveraging her recent palliative care experience.

Seshamani serves as the director of the Center for Medicare, the part of CMS tasked with formulating, coordinating and implementing policies designed to serve Medicare beneficiaries. Prior to accepting her current role, she was the vice president of clinical care transformation at nonprofit health care organization MedStar Health.

Palliative care was a big part of that job, Seshamani explained at the Home Health Care News Capital+Strategy conference in Washington, D.C., last week.

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“In that most recent role, I lead geriatrics, palliative care and community-health case management,” Seshamani said. “So really all of the areas where we think about, ‘How can we serve people and take care of them as people, who are more than just a diagnostic code that comes in for an office visit or for a hospitalization?’ I really bring all of that to my current role leading the Center for Medicare.”

There were an estimated 63.8 million individuals enrolled in Medicare Parts A and B in 2021, according to CMS statistics. More than 1.5 million Medicare beneficiaries received hospice care in 2018, the most recently available data shows.

Within Medicare, the hospice benefit, in particular, is in a period of change. Specifically, operators are navigating the Medicare Advantage (MA) world for the very first time through the Value-Based Insurance Design (VBID) program.

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So far, hospice participation in VBID – also known as the MA carve-in – has yielded mixed reviews, with some providers already seeing gaps between how the program was designed and how it’s being executed. While monitoring VBID is more in the CMS Innovation Center’s wheelhouse, Seshamani did say she’s keeping an eye on the overall balancing of traditional Medicare and MA.

“How do we optimize the Medicare program across all [its areas], so that people can get what they want and what they need from our health care system? That, at its fundamental core, is how I view all of this,” she said at the Capital+Strategy conference. “Is it moving the needle on outcomes? Is it spending the Medicare dollar in a smart way? Because we have to be fiscal stewards of the Medicare dollar, or the taxpayer dollar.”

The field of palliative care is also undergoing MA-driven change, as more and more plans start to offer home-based palliative care as a supplemental benefit.

And as value-based and palliative care models each become more prevalent moving forward, policymakers and Medicare stakeholders should be able to glean new insights on the value of a team-based approach to care.

That’s a critical part of both, Seshamani explained.

“We definitely, in Medicare, are looking to increase our footprint in value-based care,” she said. “And in holistic care models where you’re really encouraging that team-based approach to care, you’re enabling providers to come together to take accountability for cost and quality.”

“I think palliative care comes along with all the other ways that we want to improve access to care,” Seshamani added.

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