- The number of Medicare Advantage members enrolled in plans with value-based payment designs more than tripled from 2019 to 2020, CMS said Thursday.
- Approximately 1.2 million beneficiaries joined plans in the Value-Based Insurance Design Model for coverage next year offered by 14 MA organizations across 30 states and Puerto Rico. That's up from only 440,000 beneficiaries, 10 MA organizations and seven states in 2019.
- CMS also opened up applications Thursday for MA plans to test allowing MA enrollees to access the Medicare hospice benefit starting in 2021, in an attempt to coordinate care for MA beneficiaries in palliative and hospice care.
CMS has been pushing to enroll more Medicare beneficiaries in value-based plans in a bid to lower costs while improving quality. The VBID Model allows payers to test alternative payment strategies in MA plan design. This can include targeting plan design based on an enrollee's chronic condition or income status, among other socioeconomic characteristics.
A slew of large payers are participating in the model that CMS innovation center CMMI launched in 2017, including CVS Health-owned Aetna, UnitedHealth Group and Humana.
CareOregon, Capital District Physicians' Health Plan, Highmark Health, Innovacare, Medical Card System, New York City Health and Hospitals Corporation, Sentara, UPMC Health System, WellCare and Blue Cross Blue Shield in Michigan and Rhode Island are also participating in the VBID Model for 2020.
Seniors account for a disproportionately large share of healthcare spending and more are using hospice: 1.5 million Medicare beneficiaries were enrolled in hospice care in 2017, a 4.5% increase from the prior year.
Despite this, the Medicare hospice benefit hasn't been overhauled since it was added as a Medicare covered benefit almost four decades ago, according to the Medicare Payment Advisory Committee. During that time, hospice spending has continued to mount, growing more than 400% between 2000 and 2012 alone.
The average hospice length of stay has increased from 53 days to 89 days, while the median length of stay has remained flat at 17 days, according to CMS.
In the new model, MA beneficiaries can elect the hospice benefit in their MA plan, but they'll still have access to the hospice benefit in traditional, fee-for-service Medicare. The goal is to give seniors additional access to palliative care, transitional concurrent care and hospice-specific supplemental benefits, CMS said.
Currently, MA beneficiaries who want to receive hospice benefits get the majority of that coverage through FFS Medicare, while their MA coverage is only responsible for supplemental benefits. That hospice "carve-out" from MA can result in a web of rules that complicates coverage and makes it difficult to determine who's accountable for their care.
Experts have foreseen this folding-in for a while now, with Dan Mendelson of Avalere Health telling Healthcare Dive last year the siloing of MA and hospice benefits "makes no sense."
And hospice is a lucrative area for payers, sparking a recent flurry of M&A. Humana has been particularly aggressive in that arena, acquiring home health and hospice giant Kindred in 2017 for $4.1 billion, hospice operator Curo for $1.4 billion in April last year and hospice pharmacy and PBM Enclara earlier this month.