CVS Health Corporation (NYSE: CVS) subsidiary Aetna has selected Ohio’s Hospice and Pure Healthcare as part of the insurance company’s hospice and palliative care preferred provider network for Value-Based Insurance Design (VBID) in the Buckeye State.
Admission to the network means that Aetna will also cover a range of benefits for Ohio’s Hospice and Pure Healthcare patients. These include transitional concurrent care, monthly in-home support services, meals and a personal emergency response system device.
These beneficiaries will also have access to transportation services, fall prevention items and a blood pressure cuff. Ohio’s Hospice and Pure Healthcare staff will collaborate with the Aetna case manager assigned to each patient to help guide the services they will receive.
“Our goal will be to treat patients earlier in a disease process or chronic illness onset, using palliative support services as well as in some situations to provide concurrent life-prolonging therapies along with hospice,” Ohio’s Hospice President Amy Wagner told Hospice News. “This would allow for greater flexibility than the current Medicare model provides.”
Often called the Medicare Advantage hospice carve-in, the VBID demonstration project took effect Jan. 1, 2021. The carve-in is designed to assess payer and provider performance related to hospice within Medicare Advantage. Participation in the demonstration is voluntary for both payers and providers.
Joining an MA plan’s network will help hospices stay ahead of the game if and when value-based payment expands.
Even currently, some VBID benefits are limited to patients aligned with in-network providers. These include palliative care, transitional concurrent care and additional supplemental benefits.
Also, as the demo progresses, the rules governing how plans manage those networks will change.
During the first year of the carve-in, CMS requires MA plans to pay 100% of the fee-for-service per diem whether the patient chooses an in-network or out-of-network provider.
MA beneficiaries can elect to receive care from the provider of their choice, regardless of network status, though as of the program’s second year the plan can have a consultation with the patient prior to their selection.
For the final two years of the program, MA plans will have more leeway when it comes to managing payment and patient access to hospices that are in-network versus those that are not.
Over time, gaining entry into the networks could become more difficult or restricted for providers. Thus, organizations like Ohio’s Hospice and Pure Healthcare gain an advantage by forging these contracts before the CMS network adequacy standards change in 2023.
Ohio’s Hospice is a statewide alliance of nonprofit providers established in 2013 to leverage member organization’s collective size in negotiations with vendors, payers and referral sources. They also collaborate on back-office functions and share some expenses and lT infrastructure. The collaborative began with three hospice members and now includes 11 organizations.
Established in 2020, Pure Healthcare is the palliative care and supportive services arm of Ohio’s Hospice.
“It’s critical that we develop new and mutually beneficial partnerships with payers which allow them to better understand the true clinical and strategic value of hospice and palliative care for their members and the greater community,” Anthony Evans, president of Pure Healthcare, told Hospice News. “It’s equally important that Ohio’s Hospice and Pure Healthcare have the opportunity to learn how to best support payers in delivering comprehensive care to their most frail and complex members.”
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