Quality data, the key to education for hospice-payer relationships in VBID


Leveraging quality data and education when building relationships with payers will be critical to success as hospices will begin to work as part of the Value Based Assurance Design (VBID) demonstration. , often referred to as the Medicare Advantage carve-in hospice. The program started small in its first year, with 53 participating health plans, but stakeholders expect it to grow in 2022 and 2023. Data will play a key role for providers to help payers make the connection between cost savings and palliative care.

The demonstration aims to increase access to palliative care services and facilitate better coordination of care, according to the United States Centers for Medicare & Medicaid Services (CMS). Through Medicare Advantage, CMS contracts with private insurance companies to provide coverage for Medicare beneficiaries. The VBID demo launched on January 1.

Hospices have faced strong headwinds during the COVID-19 pandemic. The outbreak has made it difficult for providers to prepare for carve-in, according to Bethany Snider, MD, senior vice president and medical director of Hosparus Health, a hospice and palliative care provider serving nearly 9,000 patients and their families in Kentucky and Indiana. Nevertheless, CMS launched the program as planned.

“The hospice was very isolated. It’s at a very small level outside of Medicare. Many thought VBID would be pushed back and then the pandemic popped up, ”Snider told Hospice News during Home Health Care News‘ Medicare Advantage summit. “It’s still the future, and I hope more payers will jump in and reach out to partners and providers like hospices to help them do this work together. Part of the demonstration is figuring out what is the best way to deliver hospice care benefits in a different way, and hopefully establishing a benefit and payment structure for hospice care. This is where innovation happens.

A growing number of hospices are diversifying their services to involve patients earlier, palliative care being a major avenue. The carve-in is one of the value-based models that could promote established palliative care delivery.

Humana (NYSE: HUM) manages the largest number of Medicare Advantage plans offering palliative care through carve-in, 10 of the 53 participating plans. These plans currently cover 145,000 patients. Hosparus is a member of Humana’s Preferred Vendor Network for VBID.

“We were delighted to see the benefit of the carve-in hospice, and we made the decision very early to participate. The pandemic had a moderating effect on small plans that did not already have the infrastructure in place to participate in the first year, ”said Kirk Allen, senior vice president of home care for Humana. “We kept the momentum going and our team had built the system to move forward with our plans. It gave us an early glimpse into innovation, and I think more will follow.

Hospice and palliative care providers must be prepared to educate payers about the value of their services to patients and their families. Hospices must have the data to demonstrate that they can provide high-quality, low-cost care, especially with a provider’s track record of reducing hospitalizations, readmissions and emergency room visits, according to Snider.

“It’s better to be at the forefront, because then you have influence,” Snider said. “Use [data] as an opportunity to educate payers about the great job you’ve done, the value you bring, and then stand up for what you think this type of care should look like, ”Snider said. “Like when we talk to patients about their goals and what’s important to them, start from the beginning. [with payers]. Make sure we are all on the same page about the added value that palliative care can bring.

The ability to show cost savings and positive clinical outcomes is key to securing a seat at the Medicare Advantage table, Snider told Hospice News.

Payers will keep a close eye on quality scores and patient outcomes as the carve-in continues to take shape.

“We are looking for high quality providers for how they help artists stand out in today’s market. [Hospice Item Set] scores as an indication of their commitment to being a well-run entity, ”Allen said. “We are looking for a total cost of care mindset when it comes to a palliative and palliative care program. It is definitely an advantage for a provider if they have a mature palliative program associated with their palliative care offering, because they can provide a more consistent service.


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