Reimbursement for community-based palliative care is gaining ground in the Medicare Advantage realm.
Palliative care is among the wide range of supplemental benefits that exist within the Medicare Advantage payment landscape. The diverse social, emotional and physical support services involved in community-based palliative care have made it an increasingly appealing area for MA plans when it comes to supporting a growing seriously ill aging population, according to Marian Grant, senior regulatory advisor at the Coalition to Transform Advanced Care (C-TAC).
“The definition of supplemental benefits has expanded [and] they specifically call out home-based palliative care as a perfect example of the kind of supplemental benefit that could be offered to people with serious illness,” Grant said at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice & Palliative Nurses Association (HPNA) Annual Assembly.
Grant is also a nurse practitioner and palliative care consult service provider at the University of Maryland Medical Center. She recently joined the National Partnership for Healthcare and Hospice Innovation (NPHI) as its innovation lab clinical officer.
Recent years have brought evolutions in Medicare Advantage supplemental benefits that have broadened awareness of the quality impacts and cost-savings potential tied to palliative services, according to Grant. But much opportunity exists for palliative care providers to expand utilization in and around MA markets, Grant indicated.
Passed in 2018, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care (CHRONIC) Act widened supportive avenues for social determinants of health among seriously ill populations. The CHRONIC Act allowed Medicare Advantage payers to expand coverage of supplemental benefits such as home-based palliative care, meal delivery services, transportation assistance, adult day services, caregiving support.
Since then, community-based palliative care growth has been slow but steady in the MA landscape, according to Grant.
About 205 Medicare Advantage plans currently offer home-based palliative care services as a supplemental benefit, according to a recent ATI Advisory report. This is a rise from 180 MA plans in 2023 offering palliative services and 64 MA plans in 2020.
The expanded breadth of palliative care coverage in Medicare Advantage has helped bring much needed services to an increasingly diverse seriously ill population, according to Dr. Deborah Freeland, assistant professor at the University of Texas (UT) Southwestern Medical Center’s Department of Internal Medicine. Freeland specializes in geriatrics, advance care planning and home-based primary care.
Medicare Advantage beneficiary demographics have been changing in a positive direction in terms of reducing disparities among underserved populations, Freeland said. But equity concerns remain that could be tied to geographic availability of MA plans with home-based palliative benefits, she added.
Positive changes have included a growing volume of seniors 85 and older with lower socioeconomic status who are dual eligible to receive Medicare and Medicaid benefits, including community-based palliative care in Medicare Advantage, Freeland stated. Additionally, more Hispanic and Black populations are enrolling in Medicare Advantage plans, along with seriously ill patients from urban areas.
Despite the needle moving toward improvement, disparities persist among underserved populations, particularly in rural regions, according to Freeland.
“The lower premiums and limits to out-of-pocket costs, as well as extra benefits that enrollees get from Medicare Advantage have really helped fuel the diversity of enrollees joining. But we are also seeing disparities,” Freeland said during the assembly. “People of color are more likely to roll in lower-[quality] rated plans. We see that many quality measures are actually worse for people of color. We also see that there is disproportionate disenrollment from Medicare Advantage for those with severe illness and increasing functional impairment.”