By Jim Parker | May
23, 2019
Hospices gearing up for a Medicare Advantage
carve-in demonstration in 2021 may place greater emphasis on addressing social
determinants of health, as Medicare Advantage beneficiaries are increasingly
affected by a lack of associated services, according to a report from consulting firm Avalere
Health. Patients with dual eligibility for Medicare and Medicaid are the most
affected, according to the report.
Social determinants of health include patient
and family demographics, access to and quality of housing, food, and
transportation, as well as internet access and other socio-economic factors.
“Information on social determinants of health
will be essential for strategic planning of services and providing the
appropriate end-of-life care,” said Christie Teigland, researcher with Inovalon
Inc., and author of the report. “Factors such as living below the federal
poverty level, low education status, lack of family or social supports,
loneliness, and other social risk issues will need to be addressed to achieve
the best overall care experience for these patients.”
Hospices are uniquely positioned to address
social determinants, as most providers consider this a part of their mission,
essential to maintaining patients’ quality of life during their final days.
“Hospice has always been a population health
kind of model. This is one of the original great innovations from the very
inception of the benefit,” National Association for Home Health and Hospice
President William Dombi told Hospice News. “Hospices already look
at social determinants. They look at the family factor, housing, nutrition, and
how the overall environment affects patient care.”
The health care industry at large, as well as
payors and regulators, are beginning to pay increased attention to social
determinants.
Last month, the U.S. Centers for Medicare
& Medicaid Services (CMS) announced that it would begin providing
supplemental non-primarily health-related benefits for certain Medicare
Advantage beneficiaries based on the patient’s specific medical condition and
needs. These benefits include a range of services from providing meals to
installing air purifiers or cleaning carpeting in the homes of patients with
asthma.
As of 2018, more than 20 million people were
enrolled in Medicare Advantage, representing 34% of Medicare beneficiaries.
Insurance giant Humana, which operates hospice
provider Kindred Healthcare, is working to expand programs to address
supplemental benefits, Home Health Care News recently reported.
United Healthcare recently collaborated with the American Medical Association
to create billing codes that clinicians can use to process claims related to
social determinants.
For its report, Avalere examined 2015 Medicare
Advantage claims and ZIP code data for more than 1.8 million beneficiaries,
finding that more than 50% of patients with full dual eligibility dwell in
locales with a median income of less than $30,000, with more than half living
in an area where as many as 20% of households are below the federal poverty
line.
Dual-eligible patients were more likely that
non-dual beneficiaries to be young, female, disabled, members of racial or
ethnic minorities, and predominantly live in urban areas.They are also more
likely to be high-acuity patients: 2.4 times more likely to suffer from
Alzheimer’s disease, and between 1.5 and 2 times more likely to suffer from
heart failure, and stroke, Avalere reported.
Though hospice utilization among patients with
those conditions is growing, dual eligible patients are more likely than
non-dual eligible patients pursue more costly forms of care such as emergency
department visits and hospitalizations. Overall health care costs for dual
eligible patients are 70% higher than those of non-dual eligible patients,
Avalere found.
In 2016, cardiac and circulatory conditions
were the second most common diagnoses among hospice decedents, representing
18.7%. Dementia patients followed close behind at 18%, with 9.5% of decedents
having stroke as a primary diagnosis according to the National Hospice and
Palliative Care Organization.
With most hospices having systems in place for
addressing some non-medical needs, they have an opportunity to capitalize on
new reimbursement opportunities when they are carved into Medicare Advantage,
whether they provide the services directly or partner with other community
organizations.
“There are ways to invest in that at the mid
market,” Bill Frist, former U.S. Senate Majority Leader and current partner in
health care investment firm Frist-Cressey Ventures, told Hospice News. “The way
for hospice and palliative care organizations to accelerate that is to find a
business model—really a sustainable resource model— that allows the provider to
seamlessly link an individual patient and their needs, as interpreted by the
patient and family, to resources in the community. I believe that over the next
three years that model will evolve.”
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