Depending on how stakeholders play their cards, the U.S. Centers for Medicare & Medicaid Services’ (CMS) updated risk adjustment policy could lead to tightened belts — or a golden opportunity — for palliative care providers in Medicare Advantage. Much of the palliative care delivered to U.S. patients is now reimbursed through risk-based models like Medicare […]
Calls have grown louder for an overhauled design of the Medicare Hospice Benefit, but the path towards change is riddled with contrasting views over regulation, policy and payment structures. Hospice providers are hitting financial and regulatory walls when it comes to sufficiently covering the spectrum of services necessary to care for patients and families, according […]
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 […]
Medicare Advantage organization SCAN Group has invested an undisclosed dollar amount in tech-enabled hospice startup Guaranteed. The move comes nearly a year after California-based Guaranteed launched in August 2022, when founder and CEO Jessica McGlory began her own provider company two years after her father passed away. SCAN Group, parent company of SCAN Health Plan, […]
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 […]
Health care middlemen are contributing to a fragmented, stitched-together “Frankenstein’s monster” of a system that puts greater distance between patients and those who actually provide the care, according to SCAN Group CEO Dr. Sachin Jain. Even defining the “middlemen” can be a challenge because these organizations are so pervasive and multifaceted. However, these companies often […]
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 […]
Homebase Medical, a subsidiary of SCAN Group, is developing a new palliative model to care for some of the Medicare Advantage organization’s most vulnerable beneficiaries. This development comes as SCAN, the parent company of SCAN Health Plan, prepares to combine with fellow nonprofit CareOregon, which has a large Medicaid portfolio. Post-transaction, the combined organization will […]
The mission and function of the Medicare program have evolved over time, and the agency that runs it also may need to adapt to the new ways that health care organizations are doing business, according to SCAN Group CEO Dr. Sachin Jain. Jain currently leads a $4.3 billion nonprofit Medicare Advantage (MA) organization that covers […]
Federal regulators are cracking down on the private insurers that administer Medicare Advantage (MA) plans. In turn, that could dampen the growth of palliative care supplemental benefits in MA moving forward. Despite palliative care’s ability to lower health care spending and improve patient outcomes, it remains an underutilized service. That’s partly because providers are forced […]
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