Palliative care providers are increasingly turning to data analytics systems to gain an edge over their competitors when engaging potential referral partners, anticipating impacts on value-based care. Data is critical in demonstrating the value of palliative care to potential referral partners as evolving value-based payment models take effect.
The value-based insurance design demonstration project, commonly referred to as the Medicare Advantage hospice carve-in, began earlier this year, and providers in the markets where the program operates have been working hard to keep up. adapt to this new payment environment. Data analysis and management is important for hospices to expand referral networks, and providers apply machine learning tools to identify patients who need their services earlier in their illness and track outcomes. . Machine learning is a form of artificial intelligence that uses algorithms and statistical models to detect patterns in data and make predictions based on those patterns.
Patient data is often extracted from electronic health records or insurance claims. Hospices can leverage basic patient information to determine which referral relationships can be strengthened, according to Kassie Hodge, director of palliative and palliative care at Mosaic Life Care Health Systems.
“The data will help us determine which of our doctors is really giving us the referrals and who is waiting too late. This is an important thing as we look at inpatient populations and as these rules change for Medicare and where we are in this continuum of care, ”Hodge said during a recent webinar on Hospice News . “If we don’t have a good baseline, that’s a lot of manual hours spent digging up a ton of data that’s right in front of you. “
Based in Missouri, Mosaic has an average daily count of 140 to 150 patients and treats about 240 home care patients per month, according to Hodge. Missouri was just above the national average for hospice and hospice use among those who died from Medicare in 2018, at 50.2%, according to the National Organization of Hospices and Hospice and Hospice Care (NHPCO).
Of the Medicare Advantage plans, 53 will cover palliative care in 2021 through the Value-Based Insurance Design Model (VBID) in 13 states and Puerto Rico, according to the US Centers for Medicare & Medicaid Services (CMS). United. Medicare Advantage is seeing record participation levels for 2021 among beneficiaries, reaching about 42% for 2021, CMS reported.
Mosaic operates in three states: Missouri, Kansas and Iowa. No Medicare Advantage plan in these areas currently offers palliative care through VBID, but the program is expected to expand into other markets as the demonstration progresses. Many stakeholders believe the future of hospice care will be tied to value-based payment in the years to come and are preparing for Medicare Advantage even if they are unable to participate this year.
According to Hodges, having a good grasp of health data regarding patient populations will give hospices a head start over their competition as they see new referral flows.
“The data is really going to give our hospice, and even our home health care, a head start in our region, because we will know in real time where our market share is. We’re going to know what our quality measures are, ”Hodge said. “Keeping an eye on market share is very important because that’s really what helps our organization to prove itself. We are looking at where we stand in relation to our partners and how we can become the best in our region and our region.
Clinical and financial analysis can give hospices a competitive edge, according to Deborah Wesley, CEO of Addison County Home Health and Hospice. Based in New Haven, Vermont, Addison’s Daily Census averages between 450 and 500 patients, including home care and palliative care. Analytics are essential so that hospices can connect earlier to referral sources and move patients along the continuum of value-based care.
“The mix that we have in our home health or hospice, our Medicaid dispensation program, our private duty, and our move towards physical therapy are well mixed. Analytics are essential to us because they help us move patients forward on our continuum, ”Wesley said during the webinar. “We have patients who can be in different business units at the same time, and we need to know when to move them from home health or hospice, from the hospice, when they are on dispensation. ”
Hospice use in Vermont reached 42.9% in 2019, a jump of 22.26% from 2014, representing the largest increase in hospice use among people who died of Medicare nationally, according to NHPCO.
Even though VBID has yet to hit Vermont, the hospice and home care provider is “stepping forward” and using data to inform its business decisions in anticipation of payment changes, according to Wesley. She added that hospices considering participating will need to update their electronic health record systems to avoid falling behind to attract interest in the recommendation against competitors.
“If you don’t have great data tools, good plans for getting that data, and someone to help you out, then you’re going to get lost. In value-based programs, data turns into money and you have to get out of it, ”Wesley said. “When you can talk to your staff and your referral sources and tell them here’s the data for this week and this day, that is a game-changer. Being able to look at referral sources, length of stay, and analysis of individual physicians and practices helps us understand which referral sources we need to talk to about early referral.