NHPCO NewsLine Fall 2019 - 29

The seriously ill population and their
families experience gaps in care
and services. This is evident by the
escalating use of the emergency
room and hospitalization as a
seriously ill individual's disease and
symptoms progress.
At the same time, health care is
evolving and moving from
traditional fee-for-service to a
value-based reimbursement
model. Hospice will not be spared
from this evolution. The sooner
hospice organizations begin to
participate in these types of
arrangements, the better. The
seriously ill and terminally ill
patient population and their
families need us to evolve to best
meet their needs.

New Opportunities
NHPCO encourages hospices to
consider the changing health care
landscape as an opportunity to
develop community-based
palliative care services. The
hospice model of care lends itself
to best meet the needs of
seriously ill individuals and their
families; it's person- and familycentered, holistic, and
interdisciplinary.
There are opportunities for
established palliative and
advanced care services to
contract with health plans in your
geography to care for the
seriously ill population. These
arrangements are typically
reimbursed on a per beneficiary
per month model, which is more
conducive to the interdisciplinary

team. Some of these plans will
include additional dollars based
on quality outcomes. NHPCO
encourages hospice organizations
to engage in these contracts. It is
a great way to develop
relationships with plans before
the hospice carve-in model.
Similar to contracting with a
health plan, you can contract with
an Accountable Care
Organization within your
geography to care for their
seriously ill population. The ACO
might not realize the opportunity
and the value you can bring to
their population health strategy.
Hospice organizations that provide
palliative or advanced care services
further upstream provide cost
effective, supportive, high-quality
care that improves the patient and
family experience and ensures
smooth transitions between these
services for the seriously ill
population. That is a tremendous
value proposition for Medicare
Advantage plans and ACOs.
Finally, hospice organizations with
palliative and advanced care
programs have the opportunity to
participate in the new Primary
Care First Serious Illness Model.
NHPCO also encourages
becoming a preferred partner
with Primary Care First and
Direct Contracting participants.
Information about these models
is available on the NHPCO
website and includes links to
information on the CMS website
- visit the Models and Demos
page of nhpco.org.

Change Has Challenges
One word of caution: the
competencies and skills required
to care for the seriously ill are
different in many respects to
those needed to care for the
terminally ill. The physician and
non-physician practitioners are
valuable team members in
managing disease burden and
helping individuals make informed
decisions about treatments and
interventions that may impact
the quality of life.
There are also challenges given
the current limitations of
reimbursement. Communitybased palliative and advanced
care services need to be built as a
clinic practice model. That means
different documentation needs,
different billing and coding
expertise, and different quality
reporting.
Don't let those challenges
overwhelm you. Through the

the competencies
and skills required to
care for the seriously
ill are different in
many respects to
those needed to care
for the terminally ill.

Newsline / Fall 2019

29
https://www.nhpco.org/hospice-care-overview/models-and-demos/ http://www.nhpco.org
NHPCO NewsLine Fall 2019

Table of Contents for the Digital Edition of NHPCO NewsLine Fall 2019
