The post-Medicare Advantage hospice carve-in landscape could include wider value-based reimbursement avenues in the hospice space, leading providers to pivot into MA payer relationships.

The forthcoming end of the hospice component of the value-based insurance design (VBID) demonstrative takes effect Dec. 31. Launched in 2021, the carve-in was designed to test coverage of hospice care through Medicare Advantage, as well as coverage of palliative and transitional care.

Hospices will need a strong value-based payment negotiation strategy to prepare for the unknowns that lie ahead, according to Melinda Gaboury, co-owner and CEO of Healthcare Provider Solutions Inc., a hospice and home care consulting company.

“You need to be at the table with Medicare Advantage plan negotiations and make yourself known. You want to be first at the table,” Gaboury told Hospice News National Association for Home Care & Hospice’s (NAHC) Financial Management Conference in Las Vegas. “The preparation right now is getting relationships to begin, meaning get yourself to the point where you have a contract with these Medicare Advantage plans that you check in with every two or three months.”

The larger VBID demonstration continues until 2030 and covers services across the care continuum. The U.S. Centers for Medicare & Medicaid Services (CMS) cited operational challenges related to the hospice component that limited and decreased participation among Medicare Advantage Organizations (MAOs) and impacted “a thorough evaluation” of the demo.

Questions and concerns linger among providers, even as many operators welcomed the hospice carve-in’s sunset. Some saw it as a challenge to the traditional Medicare Hospice Benefit, while others cited issues with MA plans adjudication of claims denials, delayed payments and confusion on varying patient eligibility requirements among plans.

Despite the hospice carve-in’s end, hospices can anticipate their value proposition to rise among MA plans, according to Gaboury. Operators should give careful consideration to which MA plans might be the best to partner with compared to others beyond just their reimbursement rates, she added.

“A lot of your patients, if you look at your statistics of beneficiaries right now, are in Medicare Advantage plans,” Gaboury said at the conference. “If [enough] patients in your area are on a specific MA plan, that’s the one you need to target. That’s the one you’re going to want a seat at the table with, because if you don’t make that happen, you’re not going to have contracts.”

MA plans have increasingly connected the dots between quality and cost-savings potential of hospice services. Case in point, MA enrollees were less likely to receive expensive, aggressive treatment and higher hospice utilization rates during the last six months of life in 2022, according to JAMA Health Forum research.

Demographic tailwinds are also driving hospice interest as providers see a growing number of MA beneficiaries come under their services, Gaboury indicated.

Alongside the potential growth of hospice in value-based reimbursement could come a complicated payment mix for providers as VBID continues, she added.

“Before it was scheduled to end by 2025, [MA] plans that had participated in VBID in their second or greater year would not be allowed to elect an out-of-network hospice,” Gaboury said. “So if they were already going to do that in the demonstration, that’s going to happen when the rubber meets the road and all Medicare Advantage plans are dealing with hospice beneficiaries.”