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 […]
Over time, Medicare Advantage plans will likely have a greater presence as hospice payers, and now is the time for providers to build relationships those organizations. Originally slated to end in 2024, CMS recently extended the hospice component of the value-based insurance design model (VBID) to 2030. Though the demo’s ultimate outcome remains uncertain, many […]
Reduced care costs and improved health outcomes are the two key growth levers in a frothy reimbursement and revenue climate for Humana’s (NYSE: HUM) health care business, CenterWell. A focus on reducing total cost of care while improving health outcomes is a common thread among payers and providers alike in both spaces, Humana CFO Susan […]
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 […]
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 […]
The U.S. Centers for Medicare & Medicaid Services (CMS) is making significant changes in 2024 to the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) payment model. The updates include the introduction of a new approach to payment designed to enhance care delivery and care coordination for patients in underserved communities, according […]
A transition to value-based reimbursement would fundamentally change the traditional hospice business model. It could also wield a powerful influence on an organization’s culture. Hospices are inching ever closer to the value-based arena. To date, much of this has centered around diversified programs like palliative care, PACE and other services. However, the ongoing value-based insurance […]
The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients. The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and […]
Having a detailed lens into quality metrics and service costs is a key for hospices that are searching for sustainable value-based payment pathways. Quality and cost data are important pieces to bring to negotiating tables with payers in value-based reimbursement, according to Joe Calcutt, CFO of Liberty Healthcare Management. Hospices that can demonstrate the ability […]
New legislation is leading some hospices to consider what a potential community-based palliative care payment demo would mean for them — as well as what it would look like. Four U.S. senators recently introduced a bipartisan bill that, if enacted, would steer the Center for Medicare & Medicaid Innovation (CMMI) to develop a palliative care-specific […]
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