Blog Post | February 6, 2020

Medicare Advantage Organizations Gain a Competitive Edge for Inclusion in CMMI Hospice Carve-In VBID Model

Written by: Terri Maxwell, Ph.D., APRN, Chief Clinical Officer, Turn-Key Health

Terri Maxwell, Ph.D., APRN, Chief Clinical Officer, TKH

VBID Hospice Carve-in application process open to Medicare Advantage Organizations (MAOs), with applications due by 11:59 p.m. EST, Monday, March 16, 2020.

The Centers for Medicare & Medicaid Services Innovation Center (CMMI) recently released a Request for Applications (RFA) to participate in an expansion of the Value-Based Insurance Design (VBID) Model that includes hospice coverage in plan design, 2021.

Turn-Key Health, a community-based palliative care (CBPC) solution is well prepared to support Medicare Advantage Organizations (MAOs) in meeting the requirements of the CMMI RFA to participate in an expansion of the VBID Model that includes hospice carve-in and the provision of palliative and transitional care services beginning in 2021.

Turn-Key’s industry expertise and palliative care model provides MAOs with a “turn-key” solution to describe and implement the key components of the Palliative Care Services requirement:

  • Palliative care resources targeted to any appropriate sub-population(s)
  • Care coordinated for enrollees, including how providers will develop an individualized plan of care inclusive of all relevant services and providers
  • Continuing care provided to enrollees to meet their needs as their illness advances and as enrollees’ needs change based on participating MAOs’ providers’ continuing care assessments
  • Advance care planning offered through the Wellness and Healthcare Planning (WHP) requirement of the model
  • Medical, counseling and social services made available as clinically necessary and appropriate
  • A seamless transition from palliative care to hospice services provided for beneficiaries who wish to elect hospice

Turn-Key’s solution takes a proactive approach across member populations to improve the value of palliative care provided, ensure the provision of evidence-based clinical care, and improve outcomes. This includes helping MAOs to meet CMMI’s goals related to cost and quality of care for beneficiaries and addressing the need to provide palliative care services to members as part of the RFA.

Turn-Key also fosters partnerships between hospices and MA plans–organizations that have never coordinated with each other. As a leading authority in this new healthcare era, we offer in-depth knowledge into vetting hospices and identifying effective partners for optimal VBID strategies.

A Reliable and Credible Resource

Turn-Key is helping MAOs to achieve the full scope of hospice benefits as currently defined in the Social Security Act (SSA), including requirements for beneficiaries to meet the definition of “terminally ill.” We are ready to assist MAOs in the development of a robust strategy around access and delivery of palliative care services for beneficiaries who are not eligible for or have chosen not to receive hospice services.

Our CBPC Solution

By embedding our CBPC solution in their submissions and leveraging our unique market insights, MAOs can better meet the key application components and strategy requirements around access and delivery of palliative care for

certain beneficiaries not receiving hospice benefits. Our Palliative Illness Management™ (PIM), a rapidly scalable solution within insured member populations, is an innovative, high-touch, home-based program designed to catalyze patients and caregivers to be fully engaged in choosing and implementing a plan of care that optimizes their quality of life and results in treatment decisions in concordance with their goals, preferences and values.

PIM includes predictive analytics to identify members who are at risk of overmedicalization and/or would benefit from palliative care, customized workflows and specialized palliative care plans mapped across the care continuum, advanced care planning (ACP) and process to document goals of care. This approach enables better care coordination, enhances the patient experience and improves outcomes.

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