VBID Hospice Carve-In: Thriving in a New World

Outcomes 1. Utilizing a patient case to demonstrate the model experience, participants will self-report the opportunities and challenges coming to hospice.2. Participants will be able to apply key strategies at their organization to ensure their hospice organization thrives in the evolving landscape. Key Message In 2021, the Centers for Medicare and Medicaid Services (CMS) began testing the VBID Hospice Carve-In model across the country. Following 3 years of participation in all elements of the demonstration, we will help organizations prepare to thrive in this new world. Context In 2021, CMS began testing the VBID Hospice Carve-In Model. This model is testing an overhaul to the Medicare hospice benefit where Medicare Advantage plans will oversee the hospice benefit and requires the addition of community-based palliative care along with transitional concurrent care (TCC). Key requirements include maintaining the hospice benefit, access to palliative care and TCC, offering of supplemental benefits, promotion of transparency and quality, and improving access to hospice. This demonstration is slated to continue through 2030 and will drastically impact the way hospice organizations operate. Case Review A 62-year-old woman with advanced COPD and Heart Failure was admitted. Her goals of care were to prolong life and manage her COPD exacerbations while avoiding the hospital. With access to palliative care, the patient avoided numerous hospitalizations and addressed psychosocial needs. As her functional status worsened the team discussed transitioning to hospice. Given her enrollment in VBID, utilization of TCC allowed for 31 days of coverage of her AVAPs/Trilogy machine with subsequent transition to BiPAP. She received 48 days of hospice care prior to death. Conclusions Over the past 3 years in the VBID Hospice Carve-In, we have seen an opportunity to expand access to hospice and palliative care. However, it has brought unexpected challenges around ensuring volume to achieve financial sustainability, identification of the appropriate population, expansion of administrative burden and continued flaws with time-limited benefits. This presentation will share lessons learned with this model to prepare leaders to take strategies back to their organizations to succeed in this new world. Keywords Models of Palliative Care Delivery / Advocacy / Policy/ Regulations