Value-Based Insurance Design

Value-Based Insurance Design (VBID) is often referred to by hospices as the “Medicare Carve-in.” Through VBID, CMS is testing an array of value-based health plan innovations for Medicare Advantage (MA) plans. One of these innovations is the Hospice Benefit Component.

Under the Hospice Benefit Component of VBID, the MA plan retains financial responsibility for hospice and can contract directly with hospices to offer a more flexible benefit, including coverage for palliative care and concurrent treatment while on hospice. While all VBID providers must cover all hospices at this time, this requirement will change, giving hospices that have contracted as networked providers with MA plans an advantage.

Because Acclivity Health has both MAOs and Hospices as clients, we can streamline data exchange and collaboration between the two creating better care, more bonuses, and larger reimbursements. In addition, we know we hospices contract with specific MAOs within each applicable county which enables a more efficient data process.

After working with clients within VBID, Acclivity Health has identified two key performance indicators that will gauge success of the VBID program:

A) Percentage of Deaths on Hospice and B) Hospice Length of Stay.

We increase performance within these metrics by:

A) Percentage of Deaths on Hospice: Use of multiple Acclivity Health AI Mortality Models provides the early identification required to shift the initial encounter from the acute Inpatient setting to the professional setting and, thereby, promote maximizing both of the critical VBID KPIs.

B) Hospice Length of Stay: The Acclivity Health platform provides the algorithms and analytics needed to develop and manage both the palliative care network and the value-based palliative care contracts that promote utilization of the available tools and positive provider behavior.

In combination, these tools provide critical support for shifting the initiation of palliative care from the acute inpatient setting to the professional setting and maximizing both of the VBID KPIs. Acclivity Health helped one MAO save $705PMPM by focusing on these metrics alone.

VBID is a voluntary pilot as of now, but as more of the baby boomer generation grow older, it’s inevitable the hospice carve-in requirement will be mandated to ensure the best care possible for those at end-of-life stages.

Let Acclivity Health guide you through this new CMS venture – please get in touch and one of our experts will contact you.