Education for Health Plans a Key to Success in MA Hospice Carve-In

Posted Sunday, July 18, 2021

Understanding the MA hospice carve-in through the value-based insurance design model (VBID) has been a learning curve for all.  According to Erik Johnson, senior vice president of Optum Advisory Services, hospice providers have discovered a need to educate the health plans about the nature and value proposition of their businesses. The entrance of hospice into the value-based care arena has payers puzzling their way through the new benefit,

“For payers, this is all new for them. They’re not really sure what to expect or how to manage a hospice benefit or hospice network,” Johnson told Hospice News during the summit. “Like any new benefit, it’s a hard one for actuaries to price, because in the fee-for-service world it’s a benefit that isn’t used in a timely way, so the historical data that actuaries have played with aren’t a particularly good indicator of what might be able to be derived from a managed hospice benefit. There is a lot of interest in seeing how this plays out from a demonstration perspective.”

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