Over time, Medicare Advantage plans will likely have a greater presence as hospice payers, and now is the time for providers to build relationships those organizations.
Originally slated to end in 2024, CMS recently extended the hospice component of the value-based insurance design model (VBID) to 2030. Though the demo’s ultimate outcome remains uncertain, many stakeholders believe that, in the long term, hospices can expect more interaction with Medicare Advantage plans, according to Dr. Payam Parvinchiha, corporate vice president of network quality & innovation for SCAN Health Plan.
“I think the extension signals that CMS is committed to it. While they’re getting a lot of feedback from viewers like us and also around the complexities of challenges, it signals that it’s here to stay,” Parvinchiha said at the Hospice News Elevate Conference in Chicago. “I feel also signals that they’re probably not going to roll out mandatory [participation] as they were expecting to, we’ve heard, in 2026, potentially.”
SCAN is a $4.3 billion nonprofit Medicare Advantage (MA) organization that covers more than 285,000 members across California, Arizona, Nevada and Texas.
MA has emerged as a powerhouse in health care, with industry-wide implications. Total Medicare enrollment hit 58.6 million in 2022, according to CMS. Of those, MA covers about 48%.
The Medicare Advantage program grew 8% between 2021 and 2022 — about 2.2 million beneficiaries.
When it comes to hospice VBID, numbers from the program’s first year offer few clues for the 2023-2024 landscape. The program launched in 2021, coinciding with the height of the pandemic.
Participation was small in year one. A total of 9,630 VBID beneficiaries received hospice care through the VBID demo in 2021, and 525 utilized the program’s supplemental benefits, according to a report from the RAND Corporation prepared for CMS. The agency has yet to release 2022 results.
While operating within Medicare Advantage can lead to challenges for hospices, it also gives them an opportunity to develop innovative approaches to care delivery, according to Burke Wise, co-founder of the Management Services Organization (MSO) Empassion Health.
“This is a very early stage. I think right now is a fun time to go out and innovate and to try different things. I think one of the axioms of health care is that if you’re not at the table, you’re on the menu,” Wise said at Elevate. “Participating in this learning on your terms as CMS is figuring this out, [and] as the MA plans and third parties are figuring this out, is a good thing to do, before it becomes, and I’m expecting it to become, mandatory.”
Hospices and MA plans can come together around some common goals. Examples include improving hospice access and increasing lengths of stay, which ultimately contributes to a lower cost of care — a high priority among payers.
But to operate in an MA environment, hospice and palliative care providers will need to leverage a robust suite of performance data in negotiations with health plans.
CMS requires MA plans to ensure they are working with providers of high-quality care. To do this, plans look closely at star ratings, quality data like the Hospice Item Set, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores when determining which providers to include in their networks.
While most providers are already tracking numbers on a range of metrics, they may need to consider a few more when working within Medicare Advantage.
Hospices will also need to measure their performance on additional criteria to remain competitive. This will likely include data on length of stay and utilization of non-hospice services, and, increasingly, information used to gauge health equity.
Certain aspects of the MA carve-in are designed to change from year to year, and CMS has released few details on how the program will evolve during the extension years through 2023.
To date, the agency has indicated that hospice patients aligned with VBID will be able to receive some level of concurrent curative care. CMS will also place greater emphasis on health equity, care coordination and social determinants of health.
Whatever the future holds, hospices should already be in conversations with payers in order to stay ahead of the game.
“The reality is, with all sorts of different possibilities moving forward is that health plans being your payers is going to be a reality in the next five-to-10 years,” Parvinchiha said. “The sooner you can start collaborating with your local payers the better, making sure to start the process not just with national figures, but also with your local payers,” Parvinchiha said. “Because there’s a distinct differences in what those negotiations and what those interactions are gonna look like.”
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