The U.S. Centers for Medicare & Medicaid Services (CMS) is extending the value-based insurance design demonstration for calendar years 2025 to 2030, including the hospice component.
The hospice component of VBID, also called the MA carve-in, launched in 2021 and was originally slated to complete after four years. Each year, elements of the program have gone through planned changes, and that will continue through the extension.
“The Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030 and will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness,” the agency indicated in an announcement.
The agency is also releasing applications for participation for eligible Medicare Advantage organizations (MAOs) for calendar year 2024.
Through Medicare Advantage, CMS contracts with private insurance companies to provide coverage for Medicare beneficiaries. In 2023, the number of MA plans will swell to 3,998, up 6% from 2022. As of last year, these plans covered more than 28 million Americans, close to half of the entire Medicare population, according to the Kaiser Health Foundation.
The demonstration marks the first major step for hospices into the value-based care arena. While some hospice leaders question the value of the program, others have greeted the demo with more enthusiasm. But regardless of how they view VBID, most hospice providers realize that this is something that can’t be ignored.
“This entire Medicare Advantage. carve-in. It makes sense. I think there are bureaucratic reasons why [including hospice in MA] hasn’t happened. There are obviously lobbying efforts against it,” St. Croix Hospice CEO Heath Bartness told Hospice News at the Home Care 100 conference. “I think that we could work probably better with the payers to show not just the financial impact, but ultimately, the quality of care impact of keeping these prospective patients out of the hospital when they want to live life to the fullest.”
During the program’s first year in 2021, 9,630 MA beneficiaries received hospice care through the VBID demo, and 525 utilized the program’s supplemental benefits, according to a report the RAND Corporation prepared for CMS.
Among those benefits is palliative care. The program also provides one more avenue of reimbursement for palliative care, a field in which there are few options when it comes to payment models.
For VBID’s purposes, this is generally transitional services for patients who need comfort care but are not yet ready or eligible for hospice.
The additional provisions that CMS plans to implement in the extension years of 2025 and 2030 are consistent with the Center for Medicare and Medicaid Innovation’s recent commitment to include health equity provisions in all of its forthcoming payment model demonstrations.
“CMS is working hard to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people that are served by our programs by eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved and providing care and support that our enrollees need to thrive,” Laurie McWright, deputy director for CMMI’s Seamless Care Models Group, said in a CMS webinar. “I think it’s safe to say that the VBID Model Health Equity Incubation Program fits well into this vision and reflects the priority and emphasis we are placing on health equity within the VBID Model.”