Featured Health Business Daily Story, Jan. 25, 2016
Reprinted from HEALTH PLAN WEEK, the most reliable source of objective business, financial and regulatory news of the health insurance industry. Sign up for a $91 two-month trial subscription today.
Health insurers are increasingly targeting palliative care in their ongoing mission to improve quality and bring down costs associated with the most expensive aspects of care, partnering with specialty providers and launching pilot programs aimed at the terminally ill.
On Jan. 1, CMS began reimbursing physicians for conducting end-of-life conversations with their patients, a provision proposed for inclusion in the Affordable Care Act that was buried in 2009 when former Alaska Gov. Sarah Palin accused President Obama of creating “death panels.” The new billing code encourages advanced care planning and would allow the government to track how much time doctors spend discussing a patient’s care goals and final wishes. Some insurers, however, began reimbursing for these conversations on their own, a task that has been difficult to push with providers mostly because of technical issues, according to Regence BlueShield Executive Medical Director Bruce Smith, M.D.
“Even though we’re paying for these visits separately in addition to their regular visits, and lots of our docs are really committed to doing this, the challenge has been to try and educate them that they can actually send us a bill for that,” Bruce Smith tells HPW, saying he hopes the new CMS code will help turn the tide in terms of utilization. “Yes, we want you to do this. Yes, we’ll pay you. Yes, please send us a bill.”
Regence has been requesting end-of-life discussion claims since November 2014, but Smith, a former hospice and palliative care doctor, says so far the insurer has seen relatively few. Parent company Cambia Health Solutions has been a leader in the palliative care field for some time, with a dedicated research and training center at the University of Washington and a foundation that has donated tens of millions of dollars to advanced illness initiatives. The Cambia Health Foundation is launching a dedicated funding arm in 2016 entitled “Sojourns,” which will focus on creating innovative partnerships and increasing awareness of end-of-life care, moving the benefit to a more holistic approach that incorporates social workers and spiritual guidance as well.
The conversation has been snowballing in the last several years. In 2015, California became the fifth state to enact a “Death With Dignity” law, allowing terminally ill patients the right to end their lives on their own terms. Insurers and palliative care advocates see this as a separate conversation, but it brings more attention to the idea of patient choice in end-of-life care. Aetna Inc. is well-known for its palliative care initiatives (HPW 5/25/15, p. 1), and UnitedHealth Group on Jan. 7 announced a support program for caregivers that provides them with guidance on medical care, financial tips and a marketplace for commonly needed products and services like home safety devices and delivered meals.
Aspire Health, a palliative care services provider that launched in 2013, has built an impressive array of large payer clients in the three short years the company has been in operation. One is Highmark Health, which partnered with Aspire in July 2015 to offer free around-the-clock support to in-home members.
“We feel the economic value of the program with decreased hospitalizations and increased hospice utilization more than covers the cost of the program, so we’re passing that along to our members,” Tim Lightner, Highmark vice president of products and marketing for senior products, tells HPW.
The partnership is an expansion of Highmark’s current palliative care efforts. The company has offered its Advanced Illness Services program for several years, providing its Medicare Advantage members up to 10 palliative care consults per year. That program has seen a 48% decrease in ICU admissions and a 39% decrease in emergency room admissions in the last month of life. Ninety-five percent of members said they would refer friends and family to the program.
Aspire CEO Brad Smith says its program reduces hospitalizations by an average of 52% to 76%, depending on the control group used in the analysis. Furthermore, the patient satisfaction rate averages 4.9 on a five-point scale, he says. Aspire contracts with payers in value-based arrangements, receiving bonus payments for achieving goals in metrics such as reduced hospitalizations, patient satisfaction and transitions to hospice. Aspire’s service typically lasts eight or nine months per patient.
Brad Smith says the company is working on better identifying patients who could benefit from palliative care by employing palliative care specialists to examine insurer data.
Palliative care programs increasingly are targeting the caregivers as well, who Brad Smith says are sometimes more important than the patient. Regence’s Bruce Smith agrees, saying the insurer’s recent expansion of caregiver support services is a major selling point with employer clients whose HR teams gloss over palliative care benefits that don’t pertain to their generally healthy employees.
“When I start talking about the support for caregivers, they all perk up because they realize that a lot of their employees, even in the working world, are also caring for frail family members at home, whether they be siblings or parents or someone, and it contributes to a lot of absenteeism and to presenteeism,” he says. “The minute we start talking about the caregiver benefit, the HR teams start scribbling their pencils and look up and say, ‘We’d like to introduce this benefit right away. We don’t want to wait until our next renewal cycle. Can we add this on now?’”
Bruce Smith says the conversation will become much more routine in the future as awareness of advance planning and end-of-life services increases. “My hope someday is that when you go check in with your regular doctor,” Bruce Smith says, “the front desk person will ask you your name, rank and serial number, and are you allergic to any medicine, have you had your flu shot this year, and by the way, have you given an advance directive and have you updated it lately?”
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