Value-Based Insurance Design (VBID): Become a Preferred Hospice Provider
Author: Tonia Barrier, MSN, RN, CHPN, CLHP Posted: June 14, 2022
What is VBID and Why You Want to Be a Preferred Hospice Provider
VBID is a term that is becoming more common in the health insurance industry. For calendar year 2022, there are 13 Medicare Advantage Organizations (MAOs) participating in the VBID Hospice Benefit Component to provide coverage to members in select geographical areas of the United States. But what does it mean, and why should hospice providers care? As the name suggests, VBID is all about creating patient healthcare value by improving patient outcomes and lowering costs for Medicare Advantage members. Under this model, the plan's design for the hospice component is to promote seamless care transitions that improve quality and access to hospice care.
There are several benefits available to patients in select areas where MAO VBID plans are currently offered. One of the most noticeable is that they have more coverage for necessary services like hospice care. In addition, these plans often provide incentives for patients to use in-network hospice providers who deliver this integral subset of care. Though patients always have a choice in which hospice provider they utilize, this innovative design can benefit hospice providers since it encourages patients to select an in-network provider due to their commitment to clinical excellence.
For hospice providers, it is also crucial to understand the unique differences in individual MAO VBID plans. You may find more information on this in the Participating Providers section of the CMS Innovation Center. Some MAO VBID plans may prioritize certain services or offer different incentives to provide superior service to its members. The recommendation is that participating MAO VBID plans and hospice providers collaborate proactively for the best patient experience and outcomes. However, it is up to the hospice provider to prove its value for the MAO partnership when negotiating.
Things to Consider as a VBID Hospice Provider
VBID is still a relatively new concept, so hospice providers located in the service area of a participating plan need to stay informed about how it is evolving. Based on current guidance, there are a few things that hospice providers need to be aware of:
- Hospice providers must send all notices and claims to the participating MAO and your MAC. The MAO will process payment while the MAC will process the claims for CMS to monitor the model and for informational and operational purposes.
- The contracted hospice provider must confirm billing practices and processes to stay informed of any changes. * It is encouraged that hospice providers reach out to participating MAOs regarding contracting opportunities. However, the contracting element is not a requirement for the hospice provider. The participating MAO must continue to pay at least the equivalent of Original Medicare for Medicare-covered hospice care provided.
- Prior authorization requirements around hospice elections or transition between service levels are not permitted.
Best practices as a VBID Hospice Provider
As a VBID hospice provider, it is essential to adhere to best practices that ensure the highest quality and most cost-effective care for the patients served. Here are some tips to follow:
- Work with and educate your hospice teams to create interdisciplinary plans of care that are individualized and meet the needs of each patient with a focus on end-of-life goals.
- Coordinate with any other outside healthcare providers involved in the patient's care to ensure seamless care delivery that minimizes the risk for errors.
- Ensure that internal organizational processes are present to proactively manage burdensome symptoms and prevent avoidable hospitalizations.
- Use evidence-based guidelines and criteria for staff education and resources to increase clinical decision-making confidence and proficiency.
- Develop data collection systems for analyzing and consistent monitoring for best practice implementation. Measuring success and identifying areas of needed improvement are critical components of delivering quality care.
In a value-based care model, hospices must focus on meeting patient needs while ensuring efficient use of resources. To reiterate the importance, hospice partners should strive to develop data collection systems that track and monitor progress towards quality metrics, such as patient satisfaction and their ability to prevent avoidable hospitalizations. Equally as important, hospice partners should heavily focus on creating individualized care plans that meet each patient's needs and preferences. By following these best practices, hospices can further position themselves as a choice hospice provider while also helping to control healthcare costs.
The Importance of Quality Patient Care as a VBID Hospice Provider
Moving away from fee-for-service and into a value-based care model has become an increasingly important topic in the healthcare industry. As a result, more and more hospice providers are looking for new methods and approaches to further enhance the quality of care provided to their patients. Hospice providers are experts in end-of-life care, and they can help improve the quality-of-care patients receive during this difficult time. In addition, hospice providers can also help reduce the cost of care by ensuring that patients receive the services they need while avoiding unnecessary treatments through practical goals of care discussions and planning.
As a VBID hospice partner, it is vital to adhere to best practices that ensure the highest quality and most cost-effective care for the patients served. The tips we have outlined here could help you evaluate new strategies to work more effectively with your hospice teams to provide exceptional care that meets each patient's needs. If you are looking for additional support in this area, reach out to learn how Maxwell Healthcare Associates can help. Our vetted team of seasoned consultants has extensive experience in assisting hospice providers to improve their performance and achieve desired outcomes.