Dive Brief:
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HHS’ Physician-Focused Payment Model Technical Advisory Committee recommended the agency test two value-based alternative payment models in Medicare for palliative care. Palliative care makes up one-quarter of Medicare expenditures, though only 4% of beneficiaries use it.
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The committee suggested a review of the Patient and Caregiver Support for Serious Illness (PACSSI) model and the Advanced Care Model (ACM).
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Meanwhile, a new Health Affairs post explored including hospice care coverage in Medicare Advantage (MA).
Dive Insight:
The American Academy of Hospice and Palliative Medicine proposed the PACSSI payment model, which it says is needed because patients with serious illnesses are not well served in the fee-for-service payment system. The model gives tiered, monthly payments to interdisciplinary care teams delivering community-based palliative care. It would have two tracks, one has double-sided risk and the other begins with shared risk and savings.
The Coalition to Transform Advanced Care offered the Advanced Care Model. The ACM has shared savings and risk with payment tied to metrics like evidence of advanced care planning and a care team visit with 48 hours of hospital discharge.
Hospice care is not currently covered by MA. Instead, enrollees must move to traditional Medicare if they need hospice services, though MA may cover Part D drugs unrelated to the terminal condition.
MA makes up about one-third of the Medicare population and that’s expected to increase in coming years.
In 2014, the Medicare Payment Advisory Commission recommended that hospice benefits become part of MA plans. The Senate Committee on Finance also included a carve-in as part of a bipartisan chronic care proposal, but it wasn't part of a final plan.
In the Health Affairs post, authors Julia Driessen and Turner West wrote that including hospice care in the MA benefits package as a carve-in is “fraught with complexity, disquieting to many hospice providers and health plans and susceptible to misunderstanding. Consequently, any policy to carve hospice into Medicare Advantage requires a deliberative approach and must be designed in a way that is unequivocally seen as a ‘win’ for Medicare beneficiaries.”
The authors also said a “thoughtfully designed” carve-in can help patients, MA payers and hospices by incentivizing patient-centered care. It could also spark MA payers to develop serious illness strategies when members need palliative care. Payers could reward hospices in a carve-in program “for using their informational edge to innovate on how hospice care is delivered and collaborate with plans to provide more targeted models of end-of-life care.”