Hospice’s Outlook in Value-Based Care

Data are key to understanding how value-based care has helped highlight quality benefits of hospice.

The U.S. Centers for Medicare & Medicaid Services (CMS) is sunsetting the hospice component of the value-based insurance design (VBID) as of Dec. 31. Commonly called the hospice carve-in, the program in 2021 began testing the coverage of hospice through Medicare Advantage, as well as palliative care and transitional care.

Though the hospice carve-in is coming to an end, it could have lasting impacts on how value-based providers across the continuum view end-of-life care, according to Mindy Stewart-Coffee, national vice president of palliative care at Landmark Health, part of the UnitedHealth Group (NYSE: UHN) subsidiary Optum Home & Community Care.


A common thread that the carve-in has helped demonstrate is that earlier and longer access to hospice services can have quality outcome benefits, a key measure for upstream referral sources in value-based care, Stewart-Coffee said at Transcend Strategy Group’s GRO Summit.

“The VBID hospice carve-in demonstration is coming to a close at the end of this year, but value-based entities are becoming more common upstream [of] hospice referral sources at an increasing rate,” Stewart-Coffee said during the summit. “They evaluate really similar data to identify community partners. So, it’s worth it to understand how you compare to your peers in these focus areas, and also to really understand what’s driving your results so you can speak to it with potential partners.”

The ability to show ties to hospice outcomes and reduced rehospitalizations and high costs at the end of life is among the greatest strengths a provider can demonstrate to referral sources, Stewart-Coffee stated.


As the larger VBID demonstration continues its course through 2030, upstream providers will continue honing their focus on hospices that can help manage populations with a wide variation of serious illnesses, including those that fall into the highest risk in terms of payer costs tied to mortality, she added.

Readmission rates and cost savings are two important measures for referrals, Stewart-Coffee indicated.

“Make sure that you understand your own data and understand how you’re performing against some of those measures that are really important to value-based care,” Stewart-Coffee said. “And then evaluate the population you serve and how the unique, innovative things you’re doing within your organization might align to the goals and challenges of a potential partner. [It’s] understanding how the services you provide support value-based population health efforts of your potential partners.”

Timely response to referrals is a key to navigating a post-VBID landscape in hospice, according to Katie Andler, national director of hospice partnerships at Landmark.

Data around longer lengths of stay tied to quality outcomes and reduced costly health care utilization at the end of life are two of hospices’ key levers in driving their value proposition among upstream referrals, Andler said during the summit.

“The value-based care organizations are realizing what [that] longer length of stay is okay and actually adds value,” Andler said. “That window of time to serve referrals is really sensitive and makes a difference for patients and families. So, if you can outreach the same day as a referral, that’s huge. For length of stay purposes, there’s times where its seven days or less that people are getting hospice care and they’re not really getting that full benefit of hospice during that time.”

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