The Centers for Medicare and Medicaid Services’ Primary Care First (PCF) model will start in 2021, including the Seriously Ill Population (SIP) model. The SIP program is designed to improve care for high-need, high-risk patients who currently receive fragmented or inadequate care. To do this, CMS will assign SIP patients to participating hospice programs, paying the providers to coordinate their care and avoid unnecessary hospitalizations.

In 2019, Acclivity Health helped hospices prepare for the SIP model by conducting 114 SIP Readiness Assessments for organizations across 25 of the 26 regions eligible to participate. The assessments included an IT gap analysis, community partnership search, patient data analysis, and financial modeling to identify potential hurdles to a hospice organization’s success once accepted into the SIP program. Overall, Acclivity provided services to support more than 700 of the 2800 total applications submitted for inclusion in CMS’ SIP program. 

Through our work with various hospice organizations, we saw trends of substantial participation in states, including Louisiana, Virginia, Michigan, Ohio, and Florida. Acclivity has helped organizations with footprints in every single state with the exception of Alaska. Many of the hospices that applied had an ADC of under 150, indicating the critical need for these smaller organizations to be able to partake in SIP’s reimbursement for patients who are at risk or suffering from fractured care. Small hospices are not the only ones taking part in this reimbursement shift — large hospice organizations such as Compassus, Seasons, Amedisys, and more have also submitted applications.  

“What this tells us,” Acclivity CEO Jeremy Powell remarks, “is that hospices of all sizes are looking for the best way to be successful not only in the critical whole-person care that hospice is known for, but also within their razor-sharp operating margins — and for a lot of these organizations, that path leads them to utilizing smart technology.”

For hospices participating in the CMS SIP program, there are important factors that hospices will need to address when caring for patients outside of their usual census. Predicting staffing needs, analyzing incoming patient’s data from CMS, and resolving any IT or care delivery gaps will be crucial to the success of an organization in this program.  

Although this may seem like a lot to take in, this new program will easily open the door for hospices to build crucial relationships with primary care practices and Medicare Advantage payers. 

“Now is the time for hospices to hold meaningful conversations with Medicare Advantage payers on how to partner together moving forward,” Powell advises. “We urge anyone who needs assistance with this step to reach out. Partnerships between these payers and hospice providers benefit everyone — most of all, our most at-risk patients.”

For more information on how you can ensure success in the PCF SIP program, please visit acclivityhealth.com/primarycarefirst or email us at info@8kw.3ce.myftpupload.com.