Palliative care is a foundational principle of medicine that dates back to caregivers who understood the need to relieve a person’s suffering. In modern times, palliative care has become part of the broader healthcare continuum and is practiced in acute and community-based settings. Through the Hospice Value-Based Insurance Design (VBID) model, community-based palliative care can continue the tradition of providing relief to patients in need. To help providers run an effective community-based palliative program in the Hospice VBID environment, Axxess created a one-page resource that highlights the important considerations when working as a third-party contractor.
Ryan Klaustermeier, RN, Vice President of Professional Services at Axxess, created the resource and explained important factors that providers should consider as they explore community-based palliative care.
Work with Industry Experts
Before spending tens of thousands of dollars to start a palliative care program, Klaustermeier recommends doing an in-depth financial analysis. However, the person performing that analysis should have experience in the current palliative care and hospice Medicare Advantage landscape.
“You don’t want someone who is just going to crunch the numbers,” said Klaustermeier. “The right analyst is candid with you and understands what MA payers are paying for palliative services. You want them to leverage their network to ensure you’re able to properly forecast and negotiate with the payers.”
Having that expertise, he said, will help to avoid a negative return on investment. For providers who aren’t sure where to start with finding a financial analyst with experience in hospice VBID palliative contracting, Klaustermeier suggests reaching out to state or national associations for a list of recommendations.
Know Your Customer
The maxim “the customer is always right” applies to palliative care in the hospice VBID model, but Klaustermeier reminds providers to remember who the customer is in this case: the payer.
“Medicare Advantage organizations are not going to get involved with just anyone.” said Klaustermeier. “With value-based arrangements, it’s all about quality metrics and producing the expected quality outcomes that the payer has.”
Klaustermeier stressed that having quality metrics will also help when negotiating with payers. And he pointed out that having an existing program with demonstrable results will also help to leverage a better margin during negotiations with the MA.
“It’s not this ‘Field of Dreams’ where if you build it, they will come,” said Klaustermeier. “Design your program to be viable in a fee-for-service environment and then you’re more likely to have a better seat at the negotiating table.”
Protect Yourself
There can be risks and uncertainties in any hospice value-based environment, which is why Klaustermeier outlines several things providers should consider in order to protect themselves. These include clearly defined payment timelines, termination clauses, and the outcome metrics that matter most, among others.
“You don’t want this venture to put you out of business,” said Klaustermeier. “Taking steps to protect yourself also helps protect the needs of the community you’re serving because if you’re not around, they suffer.”
Axxess Palliative Care is built to support community-based palliative care providers in the Hospice VBID model or any value-based contract. Leveraging its features and the Axxess Business Intelligence suite can help to extrapolate the metrics that payers are most interested in. And the solution is built to operate under multiple payment modalities.
To download Klaustermeier’s resource guide on palliative care contracting in Hospice VBID, click here.
Axxess Palliative Care, a cloud-based palliative care software, was built for flexibility with streamlined workflows from intake to claim submission.
