As more health care reimbursement migrates towards value-based payment models, providers will need to master the art of care coordination.
Seriously ill patients can easily fall through the cracks in a fragmented health care system, leading to poorer outcomes and costly hospital stays and emergency department visits. Closing these gaps is a rising priority in payment model demonstrations by the Center for Medicare & Medicaid Innovation (CMMI).
“The health system must recognize and meet people’s medical needs by considering their preferences, values, and circumstances, should strive to keep people healthy and independent, and help providers coordinate care seamlessly and holistically across settings in a manner that puts people at the center of their own care,” CMMI indicated in a document released last year that outlined shifts in the center’s strategic direction.
The work being done at CMMI has a direct impact on hospice providers. This includes programs such as Medicare Advantage, the Medicare Care Choices Model, Primary Care First, and Accountable Care Organizations (ACOs). The center is a component of the U.S. Centers for Medicare & Medicaid Services (CMS).
CMS is gradually migrating some hospice payment structures towards value-based care programs. The highest profile example to date is the hospice component of the value-based insurance design model, which tests the inclusion of those services in Medicare Advantage. These programs also offer pathways for palliative care reimbursement beyond fee-for-service billing for physician services.
But for providers to yield the potential benefits, they must make strides toward better-coordinated care.
“Communicating and an actually collaborative workflow is still something that is very difficult. There’s just a lot of places where people need to interact as care is shifting into the home setting,” Ashish Shah, founder and CEO of Dina, told Hospice News. “It’s not just as simple as arranging one service. When you layer in durable medical equipment, transport, communicating with family, and the upstream provider, those communication challenges grow.”
Founded in 2016, Dina is a health care technology platform designed to optimize patient transitions into home-based care, remotely monitor patients to support aging-in-place, and use data to identify and inform care plans. Shah describes the platform, which recently made Inc. magazine’s list of fastest-growing U.S. companies, as an example of “care traffic control.”
Essential processes such as hospice referrals can entail a complex web of touch points involving multiple individuals or organizations, including upstream providers and payers.
Efforts to streamline these functions are becoming increasingly important as the home-based care workforce dwindles and demand rises for their services, according to Shah.
“We think of that as discharging a patient out of a hospital, and it sounds simple when you say it that way. But when you really unpack it, there could be 25 different communication streams that are embedded within that one hand-off.”
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