Is Carving Hospice Benefits into Medicare Advantage Plans a Good Idea?

CMS has started to experiment with a value-based version of Medicare Advantage (MA) that allows plans to tweak their offerings in various ways to see whether they might improve outcomes. They can, for example, design benefits to target people with chronic conditions or in ways that take into account socioeconomic factors.

One of those possible value-based offerings is hospice benefits, which have traditionally fallen outside of Medicare Advantage. This year, 13 MA organizations are offering hospice benefits.

“Carving” hospice benefits into MA plan offerings could have some benefits, as Claire K. Ankuda, M.D., M.P.H.; R. Sean Morrison, M.D.; and Melissa D. Aldridge, Ph.D., discussed in an opinion piece published in November in JAMA. Inclusion of hospice benefits could knit together care and improve the coordination that is so often lacking in American healthcare, noted the trio from Icahn School of Medicine at Mount Sinai in New York. And MA plans could be held accountable for both the quality and the cost of hospice care.

But they also had some qualms. Ankuda and Morrison were co-investigators (along with three other investigators) of a study that surveyed family and friends of people in MA plans about the quality of end-of-life care. The results, which were published in JAMA Network Open in 2020, showed that family and friends of beneficiaries in MA plans were more likely to report that care was “not excellent” and that they were not kept informed than family and friends of beneficiaries in traditional Medicare.

The popularity of MA has surged, but research findings have shown that older beneficiaries with more medical issues than younger ones are more likely to leave MA plans.

In the JAMA opinion piece, Ankuda, Morrison and Aldridge discuss how some for-profit hospice companies have skimped on care to improve their margins and how there’s the potential for that happening in the carve-in MA plans. They hold out rigorous regulation and quality measurement as a way to counteract tendencies in that direction.