New Dementia-Focused Payment Model Emphasizes Caregiver Support

Without family caregivers, most hospice and palliative care patients would be unable to receive care in the home. Now, some emerging payment models are including caregiver support as a key component. Case in point is the Guiding an Improved Dementia Experience (GUIDE) model, which the U.S. Centers for Medicare & Medicaid Services (CMS) unveiled in […]

MedPAC Calls for Freeze on Hospice Payment Rates

The Medicare Payment Advisory Commission (MedPAC) has voted to recommend a freeze on hospice payment increases starting in 2025. However, the commission pulled back on prior calls for cuts to the aggregate payment cap. While MedPAC cannot implement policy or payment rate changes, it does make annual recommendations to Congress and the U.S. Centers for […]

‘Long-Term Business Viability’ a Top Driver of Hospice VBID Participation

Providers see sustainability and expanded service growth as main draws to participating in the Medicare Advantage hospice carve-in. However, these opportunities come alongside administrative and billing challenges, among others. Hospice participation in the value-based insurance design (VBID) model has been slowly increasing over the past two years, a trend anticipated to continue as more providers […]

Caregiver Support a ‘Significant’ Priority in CMMI Models, VBID

Unmet caregiver needs are a top issue to address in developing end-of-life care models encircling the Medicare landscape. Among top priorities in current and future payment models is to improve care for those with serious and terminal illnesses, which includes caregiver support, according to Purva Rawal, chief strategy officer for the Center for Medicare and […]

Health Equity a Driver in New CMS Payment Models

The U.S. Centers for Medicare & Medicaid Services (CMS) has been working health equity components into new alternative payment models. Much movement has taken place in the payment and policy realms towards closing disparities among underserved populations, according to Hope Glassberg, senior policy advisor at the Coalition to Transform Advanced Care (C-TAC) and president of […]

Health Plan Participation in Hospice VBID to Shrink in 2024

Health plan participation in the hospice component of the value-based insurance design model (VBID) will fall in 2024. For calendar year 2024, 13 Medicare Advantage Organizations (MAOs) will participate in the program’s hospice component, providing coverage through 78 health plans in 19 states. In 2023, 15 MAOs participated in hospice VBID, including 119 health plans […]

The Role of Medicare Advantage in Growing Palliative Care Services

For the time being, Medicare Advantage may be providers’ best bet for palliative care reimbursement. The U.S. Centers for Medicare & Medicaid Services (CMS) also allows Medicare Advantage plans to cover palliative care as a supplemental benefit. In addition, the agency has integrated palliative care components into the Value-Based Insurance Design Model (VBID), often called […]

The Strategy Behind CMS’ 2024 Updates to ACO REACH

Three principles are guiding the U.S. Centers for Medicare & Medicaid Services’ (CMS) 2024 updates to the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model: care coordination, managing health equity-related risks and social determinants of health. Among a number of new requirements, the agency will also require participating organizations to develop […]

VBID Hospices Operate in a ‘Teeter-Totter’ Landscape

Evolving network adequacy requirements within the value-based insurance design (VBID) model demonstration have some hospices concerned that Medicare Advantage payers may have narrowed views on reimbursement and access.  This year the U.S. Centers for Medicare & Medicaid Services (CMS) introduced changes to the VBID model that included modifications to network adequacy requirements for Medicare Advantage […]

Quality Data, Cost Control: Hospices’ ‘True North’ in Medicare Advantage

Medicare Advantage plans are connecting the dots between quality scores and care delivery costs. When choosing a hospice to work with, payers in the Medicare Advantage (MA) realm zero in on providers’ quality scores and its patient population growth potential, according to Frontpoint Healthcare CEO Brent Korte. Consequently, those are key data pieces for hospices […]