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THE HOSPICE BENEFIT COMPONENT OF THE CMS VALUE-BASED INSURANCE DESIGN

Tuesday, January 12, 2021

The Centers for Medicare & Medicaid Services (CMS) has released the list of nineteen (19) Medicare Advantage organizations (MAOs) through 53 Medicare Plan Benefit Packages (PBPs), that will participate in the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model starting January 1st, 2021. These PBPs will test the Hospice Benefit Component in service areas that cover 206 counties, which aims to test how including hospice into the MA program (i.e. “carving” it in) will impact care quality, coordination, and costs for seriously-ill MA beneficiaries.

CMS is testing how the hospice benefit component, when moved to the health plan risk pool, can improve beneficiary care through greater care coordination, reduced fragmentation, and transparency. MAOs participating in the hospice benefit component will be required to outline how they will provide palliative care to eligible enrollees, irrespective of the election of hospice, and may make transitional, concurrent care services as well as hospice-specific supplemental benefits available to enrollees who elect hospice through network hospice providers.

Organizations participating in VBID, working with their network of providers, will be required to offer each enrollee improved, timely access to Wellness and Health Care Planning (WHP), including advance care planning (ACP). Health plans are expected to lead to improvements in the delivery system infrastructure for accessing, maintaining, and updating advance directives. Better access to advance care planning documentation resulting from this test should improve effectiveness and impact in avoiding unwanted and unnecessary care. Through the VBID Model, CMS will evaluate the impact on quality and cost of best practices for performing WHP in the Medicare Advantage population.

Iris Advance Care Planning

Iris Healthcare delivers the industry’s most comprehensive Advance Care Planning (ACP) solutions. Our primary mission is to transform the experience of serious illness by enabling people to choose the care they want and avoid the care they don’t want. Iris is a team of healthcare experts that help people set their goals for living well and we facilitate making care plans that support these goals.

Iris’ clients include health plans and other risk bearing organizations (integrated delivery systems, ACOs and large medical groups) across the U.S. through a tele-health platform. Iris ACP focuses on combating unnecessary and unwanted care delivered to people with serious illness which acts as a lever to reduce one of the largest drivers of waste in our healthcare system.

Iris offers a scalable solution with comprehensive and a best-in-class guided ACP approach to your HNHC members. We reduce the care that is unwanted, unnecessary or non-beneficial. Our enterprise-wide ACP solution can help you address Quality Metrics and Regulatory Requirements, such as Value-Based Insurance Design (VBID), the Care of Older Adults HEDIS measure, and shared decision making.

Benefits of Partnering with Iris Healthcare

Using an external advance care planning partner whose sole focus is on helping plans and their members complete ACP, is critical in a member’s care journey. It can make all the difference in their experience.

Iris’ highly trained ACP experts are able to have in-depth conversations with each member, taking the time to listen, counsel and provide support for members to determine their desired course of action. Partnering with Iris for these critical communications ensures your members receive the in-depth conversations and thorough documentation. Iris is well-versed in the nuances of ACP regulations, including differences in advance directives for each state and the necessary steps to tailor a plan to members’ unique and disease-specific care needs. For health plans, this means your members will receive high-quality care without adding additional pressure to your plan’s internal resources.

If you’re ready to explore an advance care planning partner, Iris is here to help. Our team of specialists have years of experience in the ACP industry, and our processes are easily scalable to accommodate all of your members, regionally to nationwide.

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