POSTED ON MONDAY, August 31, 2020
In 2021, hospices will begin using the new value-based reimbursement models and will have to learn to manage payment and risks within Medicare Advantage.
“They’re risk bearing in the sense that they operate on the total cost of care basis. They’re paid typically some form of a capitated per member per month payment. Then they’re responsible for the full cost of care and quality of all the members that are enrolled with them, but they’re also an emerging group of other very often provider-focused risk bearing organizations, said Gary Bacher, chief of strategy, policy and legal affairs for Virginia-based Capital Caring Health in a Hospice News Virtual Summit on Value-Based Care. “We can think of risk in two ways. There’s taking longitudinal risk, which means risk spread over a long period of time, year over year even. And then there’s episodes, where somebody might be responsible for a particular episode of care and a time period that follows the episode. These organizations, whether they’re involved in taking longitudinal risk or episodic risk, are responsible typically for a total cost of care and quality for beneficiaries.”
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