Hospices Exploring MSOs Amid Evolving Consolidation Rules

Entering agreements with management service organizations (MSOs) may be an alternate route to joint ventures, mergers and acquisitions for hospices seeking to build scale and sustainability than in today’s regulatory and financial climates. A slew of regulatory moves have taken place in 2023 that can have an impact on future deal-making in the hospice space, […]

Key to the Continuum: Hospice Providers Eye Primary Care Businesses

As hospice providers build out a larger continuum of health care services, some are taking a close look at the primary care space. The term “upstream” has become a watchword in hospice. Operators are increasingly realizing the benefits of creating longitudinal relationships with patients that begin well before a six-month terminal prognosis. Consequently, many have […]

Value-Based Payment Models Driving Nonprofit Hospice Affiliations

As hospices prepare for Medicare Advantage, more nonprofits are finding that creating partnerships or entering affiliations will better position themselves for payer negotiations. Nonprofit hospice affiliations have surged in 2022 and 2023. This is in addition to the creation of several regional collaborative networks and the formation of new Accountable Care Organizations (ACOs). The gradual […]

Aetna’s President of Medicare: MA Plans Go All-In on Aging in Place with New 2024 Benefits, Palliative Care, Hospice VBID

Aetna, a subsidiary of CVS Health (NYSE: CVS), is leveraging a series of new benefits that, coupled with existing palliative care programs and ongoing hospice payment demonstrations, promise to keep patients in their homes and out of facilities. The new benefits are heavily focused on making medications affordable and addressing social determinants of health. Beneficiaries […]

The First Year of Hospice VBID Is the Hardest for Payers and Providers

Implementation of the Medicare Advantage hospice carve-in has been challenging for both payers and providers, though a recent analysis indicates that it may get easier over time. The U.S Centers for Medicare & Medicaid Services (CMS) commissioned the RAND Corp. to conduct the analysis of the program, formally called the hospice component of the value-based […]

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 […]

Where the Buck Stops, Starts in Hospice Reimbursement and Beyond

Providers and payers alike are strategizing ways to tackle current reimbursement challenges and anticipate hospice payment’s future direction. The lines between traditional fee-for-service and value-based payment systems will begin to blur as regulators seek to balance rising demand with the associated costs, according to Burke Wise, cofounder of Empassion Health. Regardless of where value-based payment […]

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 […]

How 4 Questions Can Reduce Costs, Boost Hospice Utilization

A pilot program by an Accountable Care Organization (ACO) reduced per capita health care expenditures at a rural hospital by 70% and admissions by 98%. A key component of the initiative was a “Four Questions” framework for goals-of-care conversations. The Center for Medicare & Medicaid Innovation ran the project between 2011 and 2015 at 32 […]