A main barrier to palliative care growth in the Medicare Advantage hospice carve-in is a lack of understanding of these services among beneficiaries, as well as inconsistent service delivery.
The value-based insurance design (VBID) model is among the payment avenues that allows Medicare Advantage plans to cover palliative care as a supplemental benefit. When the U.S. Centers for Medicare & Medicaid Services (CMS) launched the carve-in at the beginning of 2021, it allowed hospices the opportunity to diversify services upstream into palliative care.
Though palliative care has become a more common part of hospice experiences among patients of providers participating in the carve-in, the scope of outcomes and services provided has varied widely nationwide, according to Julia Driessen, economist at the Center for Medicare and Medicaid Innovation (CMMI)
“With palliative care, [there’s] a significant range across the number of beneficiaries receiving palliative care under the [VBID] model, as well as variation in the duration of palliative care that they received,” Driessen said in a recent CMS webinar. “There’s substantial variation when you look under the hood.”
While palliative care experiences have been mostly positive since the VBID demonstration began, those receiving this care lack the clarity around these services, Driessen indicated.
Last month, CMS issued results of the RAND Corp.’s analysis of the VBID demonstration’s first two years. The company analyzed results of the program that spanned patient data through the calendar year of 2022.
Part of the analysis included interviews with 33 beneficiaries and their caregivers around their palliative care experiences as part of the hospice carve-in.
Approximately 40% of beneficiaries who received palliative care were unable to define these services or the types of interdisciplinary care involved, Driessen stated.
These results indicate that providers have room for improvement when it comes to increasing awareness and expanding education about serious illness care, she said.
Inadequate knowledge and misconceptions about palliative care are leading reasons many lack access to these services. Less than a third (28.8%) of adults in the United States know about palliative care, while only 12.6% can define it, according to a 2020 study from the Journal of General Internal Medicine.
“Beneficiaries who received palliative care under the [VBID] model as part of the hospice component lack a familiarity with palliative care [and] could not identify both what palliative care is in definition and the types of services that comprise palliative care,” Driessen said. “Majority of the beneficiaries and their caregivers struggled with one or both of those elements, indicating a potential opportunity for beneficiary education and moving beyond the awareness piece.”