Transcription
The Power of Partnership:Medicare Advantage and HospiceDr. April Krutka, Medical Director, Palliative CareJenifer Curry, RN Manager Personalized Care SupportKimberly Hadeed, RN, BSN Personalized Care Support Clinica LiaisonApril 19, 20221 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Medicare Advantage what?2 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
If you remember one thing .Hospice mattersto MedicareAdvantage3 2022 Regence. All rights reserved. Private and confidential.MedicareAdvantagematters toHospiceRegence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
What is Medicare Advantage? Medicare Advantage plans are approved by Medicare but are run by private companies. Medicare beneficiaries can choose to receive their benefits through a MedicareAdvantage Plan, rather than directly from Original Medicare. “all in one” alternative to Original Medicare Medicare-covered services are provided through the Medicare Advantage plan.(EXCEPT HOSPICE!!) Medicare Advantage Plans have flexibilities that are not offered through OriginalMedicare. Usually, lower out of pocket costs Offer high quality networks due to strong relationships with providersAHIP Reference4 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
About RegenceRegence serves more than 3.4 millionpeople through its Regence health plans inIdaho, Oregon, Utah and Washington. EachRegence health plan is a nonprofitindependent licensee of the Blue Cross andBlue Shield Association. Regence is part ofa family of companies dedicated totransforming health care by deliveringinnovative products and services thatchange the way consumers nationwideexperience health care. For moreinformation, please visit Regence.com.5 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
VBID Benefit Hospice Component Pilot(Medicare Advantage Hospice)6 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
What bet was made and why .“Efficient MA plans may be able to capitalize on their administrative flexibility to provide better value tobeneficiaries who enroll in their plans.”Original Medicare (“FFS Medicare) Lower administrative costsUnconstrained choice of healthcare providersLacks coordination incentivesLimited in ability to coordinate careMedicare Advantage Flexibility in payment methods Individual provider negotiations Care management for members who have gaps incare delivery, quality, outcomes Robust information systems to enable providerpartnerships Predictable cost sharing Rewards for “good” providers High Quality NetworksSource: MedPAC report to Congress March 20147 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
CMMI Testing Including Hospice in Medicare Advantage CMMI built innovation into the pilot through required VBID Hospice program elements Today a MA plan cannot “unbundle” Hospice Services CMMI built protections for Hospice agencies into the pilotOriginal MedicareHospice Benefit Plan of Care Attending Physician IDT (RN, SW, Chaplain, Physician) 4 Levels of Hospice Care Related CareVBID Program Elements Medicare Advantage Hospice BenefitHospice Supplemental Benefits (optional)Concurrent CarePalliative CareWellness & Health Care Planning (Advance CarePlanning)Social Security Law: Conditions of and Limitations on Payment for ServicesMedPAC report to Congress March 2014CMS VBID Model Hospice Benefit Component Overview19 April 20228 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
9 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Hospice VBID aims to smooth transition to hospicePatient Journey with Hospice “Carve-In”19 April 202210 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Our Approach to VBID Hospice ProgramWhy Enterprise-wide commitment to the Serious Illness population and Palliative CareOur Cause: To serve as a catalyst to transform health care, creating a person-focused and economicallysustainable health care systemWhat Regence’s VBID program includes: Medicare Advantage Hospice Benefit Hospice supplemental benefit waiving co-pays for beneficiaries in Hospice Broad Transitional Concurrent Care Benefit for the first 30 days of Hospice enrollmentOther integrated solutions in place: Palliative Care Benefit with waived co-pay for Specialty Palliative Care Visits with provider incentives Waived co-pays for Advance Care Planning visits with provider incentives Personalized Care Support Program Advance Care Planning Provider Incentive Palliative Care Provider Incentive Prior Auth removal for Physical Medicine benefit for members with Serious Illness WhereMA PPO health plans in UT and OR (including Clark County, Wash.)Who 80,000 MA PPO health plan membersWhenEntered Jan. 1, 202219 April 202211 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Personalized Care Support Program(PCS)12 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Personalized Care Support ProgramSerious IllnessIdentification andRisk ModelIndustryLeadership pactMember andOpportunityCaregiverData Insights13 2022 Regence. All rights reserved. Private and confidential.IntegratedPersonalizedSerious IllnessSolutionsRegence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
PCS in Action!14 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
PCS in action!HospiceAgenciesWorking TogetherMember ResourcesOngoing are teamThe Path ForwardSpecialists15 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
PCS in action!Regence BCBS is the only payer participating in VBID Hospice in the state of ORReferenceOregon in Network Hospice Agencies16AMEDISYS OREGON LLCHEART N HOME HOSPICEODYSSEY HEALTHCARE OPERATINGASANTE ROGUE REGIONAL MED CTRHIGH DESERT HOSPICEPACIFIC HOME CARE ASSOCIATES, INCBRIGHTON HOSPICE OREGONHOSPICE CARE OF THE NORTHWESTPINNACLE HOSPICE CAREBRISTOL HOSPICE OREGON LLCHOSPICE OF REDMONDPROVIDENCE HEALTH & SERVICESOREGONBRISTOL HOSPICE - EUGENE LLCHOUSECALL PROVIDERS SERVICES LLCSEASONS HOSPICE & PALLIATIVE CAREOF OREGON LLCBRISTOL HOSPICE-ROGUE VALLEY LLCINSPIRING HOSPICE PARTNERS OF ORSERENITY PALLIATIVE CARE & HOSPICECARE PARTNERSKLAMATH HOSPICESOUTH COAST HOSPICECASCADE HEALTHLUMINA HOSPICE & PALLIATIVE CAREWILLAMETTE VALLEY HOSPICECOASTAL HOME HEALTH & HOSPICEMT HOOD HOSPICECONNECTED HEALTHCARE INCNORTHWEST HOSPICE LLC 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Reminders .17 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Our Path Forward to Improve the Care JourneyTogether, We Are Stronger: MAOs and Hospice Agencies Data Models: The world needs to hear the Hospice story Look beyond what happens during a member's journey with advanced illness Champion your successes: Leadership: Hospice providers have been taking clinical and financial risk since 1983 “Risk without reward” Leadership: Understand the Hospice reimbursement model in the context of VBA contractingtoday It is all about the language Partner with Medicare Advantage Orgs: Hospice Agencies are new to Medicare Advantage, Medicare Advantage is new to HospiceAgencies19 April 202218 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
We want to hear from you!Together, We Are Stronger: MAOs and Hospice Agencies Resources: ProviderVBIDQuestions@regence.com Link to information on Regence.com Enter Zip Code Click VBID Hospice tab at the top19 April 202219 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
Q & A – thank you!20 2022 Regence. All rights reserved. Private and confidential.Regence health plans are Independent Licensees of the Blue Cross and Blue ShieldAssociation serving members in Idaho, Oregon, Utah and select counties of Washington
What is Medicare Advantage? Medicare Advantage plans are approved by Medicare but are run by private companies. Medicare beneficiaries can choose to receive their benefits through a Medicare Advantage Plan, rather than directly from Original Medicare. "allin one"alternative to Original Medicare
