By Congresswoman Allyson Y. Schwartz and Katie Smith Sloan
At any given time, 1.4 million Americans may find themselves in need of compassionate hospice care to guide them through their final months. The decision to transition to hospice can be heart-wrenching for a patient and their loved ones, but this option is also helping many to find peace and comfort at the end of life.
As supporters of the high-quality, coordinated care that are driving principles of both the Medicare Hospice Benefit and the Medicare Advantage program, we at Better Medicare Alliance and LeadingAge believe that there is potential for a marriage of these two systems of care to create an integrated experience for Medicare Advantage beneficiaries at the end-of-life.
A voluntary demonstration project from the Center for Medicare and Medicaid Innovation (CMMI) would allow Medicare Advantage plans to offer hospice care in all 50 states as part of its benefits package beginning in coverage year 2021 and running through 2024. During this time, CMMI will test “the impact on payment and service delivery of incorporating the Medicare Part A hospice benefit with the goal creating a seamless care continuum in the Medicare Advantage program for Part A and Part B services.”
Medicare’s hospice benefit has remained relatively unchanged since its inception in 1982 and its structure has served and continues to serve many beneficiaries well. However, this demonstration looks to remedy some of the barriers to care that have emerged over the course of the history of Medicare Hospice Benefit and we are excited for the potential lessons to be learned.
Importantly to LeadingAge, the demonstration project looks to incentivize longer lengths of stay in hospice and to provide access to serious illness care earlier in the course of a person’s disease trajectory. Currently, Medicare requires that patients give up curative treatment to elect hospice and have a life expectancy of six months or less. While the demonstration project maintains the six-month rule, it also requires that participating health plans offer opportunities to experiment with access to supportive palliative care earlier in the disease trajectory and transitional concurrent care in hospice. This may provide incentives for longer utilization of hospice that allows patients and their families to experience the benefits of hospice care more fully as well as providing a greater continuum of serious illness care.
Key for Better Medicare Alliance, CMMI’s demonstration project can minimize fragmentation in health care by allowing a patient enrolled in Medicare Advantage to stay with the team of providers they know and trust; creating a seamless care continuum from curative treatment to palliative care and hospice. If achieved, this continuity of care would attain the model goals, align with the principles of care coordination and integration intrinsic to Medicare Advantage and the hospice benefit, and help more patients live comfortably and with dignity during their final months of life.
The hospice provider community and Medicare Advantage plans are new partners to one another, and each side has lessons to learn about how to work together for the benefit of patients and their loved ones. The CMMI demonstration offers an opportunity to address unanswered questions around how integration into a managed care environment will impact reimbursement, access, and administrative burdens for both plans and providers. We see a continued role for stakeholders, like Better Medicare Alliance and LeadingAge, to work alongside CMMI and provide forums for dialogue between all parties throughout this demonstration.
Both Better Medicare Alliance and LeadingAge believe CMMI’s Medicare Advantage hospice model can make significant strides towards a more fully integrated system designed around older adults’ needs. LeadingAge has led this effort, including its white paper on integrated service delivery. Likewise, Better Medicare Alliance hosted several convenings on this issue and most recently spoke to the advances in integrated care that could be achieved by allowing Medicare Advantage participation in hospice in an issue brief released just last month.
Together, our organizations share a vision of a care system that engages those individuals approaching hospice eligibility to assess their health, social service, and financial needs. We believe that quality health care for vulnerable older Americans means working with patients and families to determine how to best optimize quality of life, meet personal goals, and prevent undesirable situations like falls, dangerous drug interactions, or needless hospitalizations. All of these factors are critical components of hospice care, as well as principles that can be applied prior to electing hospice and can help support a person with a serious illness.
We will continue to monitor the progress of this model as plans and providers partner to help beneficiaries experience coordinated care at the end of life. Better Medicare Alliance and LeadingAge commend CMMI both for the model goals and for their engagement with stakeholders in the development of this model. The evaluation of this model should provide critical information to inform the future of serious illness care.
Allyson Y. Schwartz is the President and CEO of the Better Medicare Alliance, a policy and search organization dedicated to improving health care through Medicare Advantage.
Katie Smith Sloan is the President and CEO at LeadingAge, an association of 6,000 nonprofit aging services organizations dedicated to an America freed from ageism and the Acting President and CEO of the Visiting Nurse Associations of America and ElevatingHOME which support, promote, and advocate for the role of mission-driven home-based care providers including home health, hospice, and palliative care. VNAA is a subsidiary organization of ElevatingHOME