Humana Inc. (NYSE: HUM) is diving into the value-based insurance design demonstration — or Medicare Advantage hospice carve-in — beginning in five markets: Atlanta, Cleveland, Denver, the Louisville, Ky., metro area (including southern Indiana), and the Richmond-Tidewater region of Virginia.
Among the nine insurance companies that will participate in the Medicare Advantage carve-in during the program’s first year, Humana operates the most plans that will offer hospice.
“The markets we selected represent a good cross-section of our membership. Because our overarching goal is to ensure coordination and seamlessness for our members, we want to move carefully and limit the scope in year one,” Susan Diamond, segment president of Humana’s Home Business, told Hospice News.
Humana operates hospice and home health provider Kindred at Home, which it acquired in partnership with the investment firms TPG Capital and Welsh, Carson, Anderson & Stowe. Humana came away with a 40% stake in Kindred’s hospice, home health and community care business. The two other investors control Kindred’s acute care and rehabilitation hospitals and other rehabilitation services.
All told, 53 health plans will offer hospice through the VBID demonstration in 2021, including those affiliated with Humana. These plans cover 8% the market and a limited geographic footprint, according to data from the U.S. Centers for Medicare & Medicaid Services (CMS).
The carve-in is designed to assess payer and provider performance related to hospice within Medicare Advantage. Participation in the demonstration is voluntary for both payers and providers. Based on the geographic availability of the 53 participating plans, the program will be available to beneficiaries in 13 states and Puerto Rico.
Humana is contracting with a preferred network of hospice, palliative care and senior services organizations to provide additional supplemental benefits during the carve-in, including expanded respite care for family members. The demonstration began Jan. 1 and is expected to expire in 2024.
“Another factor in our selection is the desire to partner with hospice agencies who support what we are trying to achieve with the model,” Diamond said. “So we selected markets where preferred providers have a presence and interest in partnering with us.”
Historically, Medicare Advantage beneficiaries have transitioned to the traditional hospice benefit when they elected those services. Their Medicare Advantage plan would continue to cover any claims that are deemed unrelated to their terminal diagnosis. Switching to the Medicare Hospice Benefit also usually meant transitioning to a new care team.
Among Humana’s goals in the demonstration is to help patients stay with the same care team as often as possible and to help them access hospice earlier in the course of their illnesses, when appropriate.
“Too often, patients electing hospice care do so in the final days or weeks of life, rather than at the start of their eligibility,” Diamond said. “As a result, they and their families miss an opportunity to take full advantage of a wide range of benefits. Our goal is to allow for a single continuous care team, as opposed to the handoffs that typically occur today,”
