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Current and Emerging CMS Payment Models

Explore the intersection between hospice, palliative, and primary care in the SIP program with a focus on service offerings, patient cohorts, and impact of administrations on Medicare deficits. Learn strategies for hospices to succeed in the program and leverage benefits for mission advancement. Assess current service breadth, develop referral pathways, and prepare for value-based contracts to diversify offerings. Use data analytics, marketing, and documentation to tailor care provision based on patient cohorts and ensure cost-effective budgeting for sustainable program viability.

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Current and Emerging CMS Payment Models

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  1. Current and Emerging CMS Payment Models Intersection between Hospice, Palliative and Primary Care Part 2

  2. High Level Agenda Understanding the SIP program – Recap from Part 1 SIP Patient Cohorts – What will they look like? Assessing your Current Service Offering Areas of Focus – Succeeding in SIP under a Hospice Paradigm

  3. Impact of Administrations on Medicare Deficit Projections Even including a significantly higher GDP growth rate, current administration projects higher health care spending and higher Medicare deficits Obama Administration Trump Administration

  4. Eligible Regions and Reimbursement

  5. SIP Eligibility Practices participating in the SIP program provide the following services: An interdisciplinary care team that includes physician/nurse practitioner, care manager, RN, and social worker. Can also include behavioral health specialist, pharmacist, community services coordinator, and chaplain Comprehensive, person-centered care management ability, including ability to assess social needs of patients Relationships with community and medical resources and supports in the community help address social determinants of health, medical, and behavioral health issues Wellness and healthcare planning Family and caregiver engagement 24/7 access to a member of the care team Hospices are uniquely positioned to succeed in this new program

  6. SIP Opportunity vs. Annual Medicare Deaths (By State) # of Medicare beneficiaries

  7. Current and Emerging CMS Payment Models Intersection between Hospice, Palliative and Primary Care Part 2

  8. SIP Benefits for Hospice Mission – Advancing care for the seriously ill New Service Line – Unlock new earning potential while diversifying programming Integration into the Care Continuum – Further ingrain your organization into community networks Positioning for MA Carve-In – Formal relationships built with payers Referral Pathways – Establishing relationships with patients through SIP carries over into other service lines, like home health and hospice Building readiness for Value-Based Contracts – Metric-driven, incentive-based payment model prepares you to take on new opportunities Improved Relationship with Providers – Building mutually beneficial relationships where patient referrals go both ways

  9. Assess your Breadth of Services Mature Non-Hospice Services What is the scope of your current service offering? Some Non-Hospice Services Hospice-Only

  10. Assess your Breadth of Services Hospice-Only Services No non-hospice services offered Perhaps a hospice residence Funded through hospice benefits and fund-raising Hospice-Only

  11. Assess your Breadth of Services Some Non-Hospice Services Developing non-hospice service lines, but not a significant percentage of staffing/budget currently Community based palliative or advanced illness programs, mostly telephonic support, provided by hospice staff Limited funding resources (grants, donations, foundations, bequests, research) Some Non-Hospice Services Hospice-Only

  12. Assess your Breadth of Services Mature Non-Hospice Services Mature Non-Hospice Services Established service lines with dedicated staffing In-patient and community palliative, care transitions, PACE, advance directive consulting services, advance illness management, in-home medical visits, behavioral health clinics, DSRIP, telemedicine, home care Funding through contracts, direct insurance submission, some risk-based arrangements Some Non-Hospice Services Hospice-Only

  13. Polling Question- Which of these best describes your organization today: Hospice only? Some Pre-hospice services Many, mature pre-hospice services

  14. Areas of Focus Staffing • Current roles and utilization Budgeting • Maximizing program viability Culture • Expansion of mission SIP works regardless of where you are today Hospices can focus on serving different SIP patient cohorts based on current capabilities Care Provision • Broader care plan scope Data Analytics • Harness the power of your data Marketing • Establish program identity and voice Documentation • Adapting current EMR capabilities On-Call • Non-hospice needs after hours Networking & Contracting • Integrate with the healthcare continuum

  15. Data Analytics Make use of CMS CCLF claims files You must be able to determine which patients need which care (high, medium, and low intensity) Build patient cohorts based on prognosis You can’t be successful if you treat every patient the same

  16. Cohort Descriptions

  17. Staffing

  18. Care Provision

  19. Documentation

  20. On-Call Coverage

  21. Budgeting and Modeling Maintaining a budget for the SIP population is paramount Your reimbursement is the same for each cohort, but your cost of care is very different Average monthly cost of care for entire SIP population should be less than $275 Primary Care Cohort Number of Patients Near-Term Hospice Cohort Medium-Term Hospice Cohort Cost of Care

  22. Culture

  23. Marketing Now is the time to start thinking about how you will market the SIP program Messaging and word choice should be carefully considered on all patient-facing collateral and scripting Consider new, non-hospice branding for SIP, especially if you are currently a hospice-only organization NewCo.

  24. Networking & Contracting

  25. Acclivity Can Help You Get Started We will support you in the application process (which is non-binding), including providing template responses We will analyze the raw patient claims files provided by CMS, determining patient acuity and micro-stratifying patients into SIP cohorts We will assist with modeling incremental staffing requirements and potential financial returns, based on best-practice SIP care models We will conduct an IT gap analysis, including EHR and reporting requirements We will identify and support outreach to potential community partners to fill care gaps (if any) We offer guidance around discussions with non-Medicare payers who opt into the program We provide access to industry thought leaders and best practices surrounding SIP program Once the program begins, Acclivity provides ongoing support, analytics, workflow, and reporting capabilities to ensure your success SIP Assessment Engagement Letter

  26. QUESTIONS AND ANSWERS Do you have more questions? Send them to info@acclivityhealth.com

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