The goal of the Value-based Insurance Design (VBID) Model is to reduce unnecessary spend while promoting services which offer lasting clinical benefits. This model seeks to align health plan and member incentives by emphasizing high-value services. Hospice is one of those high-value services, as it focuses on providing comfort in those last months of life. VBID has recognized this through its optional Hospice Benefit Component.

4 VBID Components for 2021

Currently, the only mandatory component of VIBD is the Wellness and Health Care Planning (WHP) component. All others are optional. The components include:

  1. WHP
  2. Interventions based on chronic conditions and/or socioeconomic status
  3. Part C and D Rewards and Incentives Programs
  4. The Medicare Hospice Benefit Component

Medicare Advantage Hospice Benefit Component

The goal of this component is to create a seamless continuum of care experience and improve the quality of care at the end of life. The demo for the Medicare Hospice component started in CY 2021. The goal: allow CMS to evaluate the impact hospice and palliative care have on care delivery and quality of care.

2021 Participants

There are 9 Medicare Advantage Organizations (MAOs) participating in the hospice component. These include:

  • Commonwealth Care Alliance, Inc (MA)
  • Hawaii Medical Service Association (HI)
  • Humana, Inc (KY, VA, OH, CO, GA)
  • Summit Master Company, LLC (PR)
  • Kaiser Foundation Health Plan, Inc (CA)
  • Presbyterian Health Services (NM)
  • Intermountain Health Care, Inc (UT, ID)
  • Triple-S Management Corporation (PR)
  • Visiting Nurse Service of New York (NY)

CMS does require that these participating plans communicate with hospice providers in their service area.

6 Elements of the Hospice Benefit Component

  1. MAOs must offer all hospice benefits as defined by the Social Security Act and must use Medicare-certified hospice providers.
  2. Define a clear strategy to provide palliative care services to members who are not yet eligible for hospice or refuse hospice services. These can be both hospice and non-hospice providers.
  3. Participating MAOs must work with in-network hospice and non-hospice providers in order to ease care transitions and ensure timely access to appropriate care.
  4. CMMI will monitor MAO performance based on the following quality metrics:
                  – Palliative care and goals of care experiences
                  – Enrollee experience and care coordination at the end of life
                  – Hospice care quality and utilization
  5. For CY 2021, plans must cover both in-network and out-of-network providers. Out-of-network providers must be paid at a rate equal to FFS payment for hospice services.
  6. Participants will be paid a monthly capitation payment for each month the member is enrolled in hospice services. The rate is based on both related and unrelated costs paid by the FFS payment system.

The Importance of Advance Care Planning Conversations

Advance care planning is the life-long process of making and documenting future care preferences. This helps align end-of-life goals and wishes with the care the individual receives.

While it is known that most people want to die peacefully at home, the reality is that unless these wishes are expressed, individuals will receive aggressive, life-saving treatment at the end of life. And in reality, 84% of individuals who are 65 and older have not been asked by their physician to have an advance care planning conversation.

Advance Care Planning: A Gateway to Hospice

Clarifying, communicating, and documenting end-of-life wishes can increase access to hospice care. If an individual selects comfort measures only, they will (hopefully) receive a referral to palliative care and/or hospice. These services can focus on providing supportive care.

According to a report from NHPCO, in 2018, 1.55M beneficiaries received hospice care, while 50.7% of Medicare decedents received at least one day of hospice care and were enrolled in hospice at the time of death. The average length of stay was 89.6 days, but 53.8% of beneficiaries were enrolled in hospice 30 days or less.

While it is a good sign that the numbers are slowly increasing year over year, individuals and their families would benefit from hospice if enrolled earlier. While hospice is covered for up to 180 days, more than half of the Medicare beneficiaries benefited from this care for 30 days or less.

Prioritizing advance care planning conversations and understanding end-of-life goals and care preferences should be a top priority for every healthcare organization. As should driving appropriate palliative care and hospice referrals.

Current and future value-based care models are recognizing this, such as VBID, the Radiation Oncology Model, and Primary Care First. Whether you plan on participating in any of these models near-term or down the road, it is important for your organization to start preparing. And CMS has recommended investing in and leveraging digital platforms, such as Vynca, to support advance care planning, to help with tracking, access, maintenance and updating advance care plans.

About the Author

Alex Paris

Alex Paris is legal intern at Vynca. He is a third year law student at Michigan State University College of Law where he is the Notes Editor of the Law Review.