Hospice News ELEVATE: Fireside Chat with Netsmart

This article is sponsored by Netsmart. This article is based on a Hospice News discussion with Maria Warren, Vice President of Clinical Consulting at Netsmart that took place at the Hospice News Elevate Conference in Chicago. The article below has been edited for length and clarity.

Hospice News: I am here with Maria Warren and we’re going to talk a little bit about technology and value-based care.

Maria Warren: I’m really excited to be a part of this discussion today. It’s been so wonderful, hearing from all of the industry leaders, talking about hospice and how we move it forward, how we build it across the continuum, and of course, we can’t do that without interoperability data and technology to tell our story.

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HSPN: I wanted to start, could you tell us what’s been going on with the VBID (Value-Based Insurance Design) demonstration?

Warren: The VBID demonstration continues to emerge. One thing that just came out last week was the phase two reports, summarizing what happened in 2021 with VBID. In 2021, VBID was in nine MA plans. It took place in 53 planned benefit packages across 14 states and territories, and across 206 counties.

One of the things that was interesting about VBID and where they came out with this report when they released it– It’s a whopping 168 some odd pages long. It’s an interesting read, but as you go through it, you’ll start to realize only 9,630 hospice beneficiaries were part of it. Of that, as we’ve been talking about going across the continuum, moving upstream, only 27% of those beneficiaries had palliative care.

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It’s an extremely lower number than what was anticipated as part of it. As VBID now, we’re approaching the end of 2022 and then emerging into 2023, we’re going to be in 15 plans, 119 plan benefit packages, and across 806 counties. What they’re projecting is we hit just shy of 10,000 hospice beneficiaries, anticipating 20,000 hospice beneficiaries in 2022, and then perhaps double that number to 40,000 in 2023.

HSPN: Now, of course, VBID isn’t available nationwide, yet it’s in certain markets. Are there reasons why providers that are not currently seeking reimbursement through value-based models should be paying attention to what’s happening in that space?

Warren: They absolutely need to be paying attention. It’s one of those things that you can’t turn a blind eye to. Part of it is, you have to understand what’s going on, because if you’re not paying attention, and you’re turning that blind eye, you’re not ready for it. It’s going to continue to emerge. As we see that the number of states it merges in plans, counties, it’s coming near you in some way, shape, or form.

As you’re thinking about not only working with referral sources and other providers and facilities, they may start asking you for information about it, even if you’re not participating in it. They want to show how you can articulate the value that you provide to their organization, and how you care for their patients.

HSPN: Can you talk a little bit about what kind of disruption could occur in the hospice industry, as a result of Medicare Advantage?

Warren: I know many of you in the audience have home health organizations, you see the challenges that home health organizations face, from an M&A disruption. As more and more Medicare beneficiaries become of age every day, they’re opting into the MA plans. As you think about the different MA plans that are out there, are you contracted? Are you not? Authorization requirements, reimbursement challenges.

The biggest thing with transitioning from a hospice standpoint is, with Medicare, if you have a clean claim, you’re getting paid every 14 days. It’s a very good cycle, hardly any follow up required as part of it, but with an MA plan, it could be 14 days, 30 days, 45 days, depending on the challenges. One of the things that Joel set up here earlier, with the authorization requirements. When you think about that from a hospice standpoint, if it’s taking you two days to get authorizations, the patient may have already come and gone.

There’s some of the challenges that can be faced as part of it, that we need to keep in mind, if you haven’t been paying attention to MA plans, either related to VBID or in the home help space. Another way that I like to connect the dots and make others see what the challenges are, is to think about room and board. The room and board process is very cumbersome and that’s kind of a little bit of a taste, because you’re dealing with Medicaid, or the Medicaid Advantage plans.

Filling out forms, and those various obstacles that come with that. That’s one area that helps you start gleaning and seeing what could potentially be like if we have to do this for our entire patient population. Now, I know I hit on some of the not-so-nice things about MA, the disruption, and the challenges, but when you start thinking about MA plans– Let’s think of the glass half full instead of half empty. They always say they’re going to operate like Medicare, follow Medicare guidelines.

That’s what they said in home health, but we know they get different flavors and do a little bit different variety of care and what they provide. What if the MA plans made access to care a little bit easier? I think about the notice of the election process as well. What if you didn’t have to file within five days, and just those administrative hurdles, if they remove that. Or thinking about the provider overlap process that you go through, backing out, and making sure that those things are in line?

If they could handle some of those things, there could be a lot of wins. I think the biggest piece of it is the access to care, as well as the ability to move upstream and provide services to the patients. It’s one of those things, as you get into negotiations and conversations. The MA plans know how to provide coverage. You know how to provide the care. It’s important to be able to articulate those things in the conversations and leverage your knowledge, your experience, as well as your data, value, and outcomes, to bring to the table.

HSPN: Now, to your point, what do hospices need to bring to the table when they start working with value-based plans?

Warren: Data being the most important thing, over and over and over again, but it can’t just be data from stagnant dashboards and information. It needs to be able to tell a story. It needs to be real-time, and you need to be able to be innovative and have interoperability tied to it. To take it one step further, of course, you need to know your referral sources and your facilities, length of stay diagnosis codes, all of those things that are important in tracking and trending information.

You need to be able to use that information to then bring it forward and tell a story. How do you tell a story? You need to have a lot of information, not just facts that they can get from the claims. They have all that information, so you need to take it one step further. What else are you providing to the patient? With the hospice quality reporting that’s out there, there’s a lot of information that’s going to be publicly accessible. How are you going to leverage that within your organization?

How are you going to leverage the hospice claims index information to track that real-time, compare yourself to your competitors, or develop strategies to help you beat out your competitors? One of the things that continues to be part of conversations is regarding health equity, as well as social determinants of health. Now, how do you weave that into data? They may not always be different pieces of information that you’re tracking, but how will you start tracking them?

One of the things that you want to think about is tapping into your interdisciplinary care team, and have everybody profile a patient and sit there, and close their eyes. The way that the physician describes, the way that the nurse describes, or the social worker, or the chaplain, all of them are going to help you identify what’s important to that patient that you should be tracking. You can’t take it as one size fits all. It’s the eastside of where you serve in the west side, upstate versus downstate.

There’s so much variety in what you can be tracking. You want to make sure that you’re tailoring it to your population and making sure that you’re able to show and track, then what are you doing to change your care plans and your pathways, to better serve those patients as they progress through your care?

HSPN: Could you say a little bit more about where technology fits in, as providers navigate this changing payment landscape?

Warren: Technology is the key. When you think about technology, your EHR sits at the top of it. Of course, that’s the most important today, to collect the information in the visit, to have it all in one place, to document from a compliance standpoint, billing standpoint. That’s just the tip of the iceberg. When you start looking underneath the water, there’s so many other things that really drive what technology is.

It’s really thinking about care management and how do you leverage that to look at risk stratifications and scoring for patients, taking all of those social determinants of health, having real-time monitoring of those patients, to make sure that they’re getting the right care at the right time so that you’re able to intervene and adjust and do what’s needed. As you continue to work down, there’s so many different areas that you need to be having interoperability.

You need to be able to connect real-time, sending data back and forth to make sure that story is being told. It’s so much more than just being able to think about what you need to do to document, to bill, because it takes it so much further, that you really need to understand how this data comes to the table and then helps you with negotiations, with MA plans, telling your story, showing your value. How are you making sure that you’re meeting not only the patient’s outcomes, the family’s satisfaction.

Thinking about them holistically, as part of it. That’s one of the big things, that when you’re looking into patient care, and especially within their end of life as they’re progressing, that you want to make sure that those satisfaction scores are becoming more and more key as you start going out there, publicly reported as well. You have to think about all of those different data points and factors that you’re able to bring to the table and be able to articulate the value that your organization provides.

HSPN: Could you share some of the other emerging trends that hospices need to keep in mind right now?

Warren: One of the things, from an emerging trend, that we talked a lot about, is palliative care and moving upstream. As well as earlier on the panel, they talked about the length of stay within hospice and how it’s no different today than it was 10 years ago, 20 years ago, and why? When you have all of this technology and data at your fingertips, how do you get hospice, the seat at the table, to use all of these tools, to take things to the next level?

That’s one area, but the biggest area that I see as another area for opportunity is thinking about how behavioral health fits into the post-acute world, not only within hospice but within home health. As you think about, from a hospice standpoint, that psychosocial chaplain, spiritual pieces, that end of life are key, but there’s so much more mental health and behavioral health challenges that patients are facing today.

That’s definitely one area that needs to have a seat at the table and be more integrated in. Whether it’s within services that your organization starts providing or partnering with other organizations. Behavioral health has been a booming area, as Dexter showed, that there’s so much opportunity and that the market is continuing to grow and expand, and there’s M&A transactions happening. But also thinking how do we continue to work across the continuum of care?

How do we help the patient navigate, and provide them the various services, needs, and things that they need to help support the care, as well as driving value into the conversation?

HSPN: That’s a really interesting point about behavioral health. I was just talking to two CEOs about acquisitions they’ve been doing, of behavioral health hospices, they have been buying behavioral health companies. I thought that was an interesting move for people to make.

Warren: When you think about quality and the value that it drives, any patient experience, wherever you go, even as we think of ourselves as consumers, when we’re going out and we’re shopping or choosing brands, you want something that you can go and maybe get all of your shopping done, so to speak, in one stop. That’s what it’s thinking of as well. How do you make sure that you’re able to provide?

When you have that positive experience, you’re going to go back to that organization for care, regardless of what care you need, as well as then the organization being knowledgeable of what they can provide, both upstream and downstream, to meet the patient and the family’s needs.

Netsmart is committed to equipping you to deliver integrated, value-based care now and in the future. Together, we can redefine care delivery in the communities we collectively serve. To learn more, visit: https://www.ntst.com/.

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