As more health care reimbursement migrates towards value-based payment models, providers will need to master the art of care coordination.
Seriously ill patients can easily fall through the cracks in a fragmented health care system, leading to poorer outcomes and costly hospital stays and emergency department visits. Closing these gaps is a rising priority in payment model demonstrations by the Center for Medicare & Medicaid Innovation (CMMI).
Hospices must build a continuum of services to remain competitive as value-based reimbursement becomes more prevalent in health care, according to Gary Bacher, chief of strategy, policy and legal affairs for Virginia-based Capital Caring Health. Bacher is also a former chief strategy officer for CMMI.
“Hospice is a hugely important and successful benefit, but it also hasn’t changed that much in 40 years,” Bacher told Hospice News at the VALUE conference in Chicago. “For hospice organizations to really remain on that cutting edge, they can really only do that if they’re working on other service lines, working with patients and families earlier.”
Value-based care is a deceptively simple term.
A vast range of payment and care delivery systems can fall under that designation. One common principle is the concept of a population-based reimbursement, according to Bacher.
In this approach, a health care provider agrees to accept responsibility for a group of patients in exchange for a predetermined amount, typically with incentives for cost savings and improved quality.
In theory, this builds more flexibility into care delivery, allowing providers to develop innovative solutions to meet those objectives.
“The real challenge with fee-for-service payments is that they’re fragmented, and they don’t support kind of a team-based, whole-person approach to care,” Bacher said. “It’s really in some ways reorienting a little bit away from a medically focused model towards much more of a care-coordination model that draws together all different types of care.”
Hospices have been providing team-based, whole-person care since day one. Nevertheless, they need to retool if they are going to thrive in a value-based health care system.
Several of the available models require a provider to assume total responsibility for the patient. To a large degree, this is what a hospice does when a patient elects the benefit. But to capitalize on new reimbursement structures they must prepare to do so in a somewhat different context.
This often means development of additional business lines, such as palliative care, PACE, home health or home-based primary care, among others.
“I think one of the challenges for hospice organizations is that if you haven’t really invested in a community-based palliative care program that in practice effectively becomes the primary care provider — or invested in deliberate creation of a home-based primary care program — it’s harder for you to participate in these models,” Bacher told Hospice News.