Hospice
Payors
WVHPCN, a collaborative led by providers, prioritizes the expansion of hospice care utilization to enhance care outcomes, improve the patient experience, and lower the overall cost of care for seriously ill patients in the final stage of life.
WVHPCN members achieve exemplary results through their commitment to network-wide standards and active engagement in the network's data collection and quality initiatives. The network's approach enhances the management of chronic conditions, diminishes unnecessary hospitalizations and resource usage, and enhances service accessibility, all culminating in an enhanced patient experience and a reduction in overall spending.
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Recognizing the significant benefits for both payors and patients, our network is committed to fostering, broadening, and enriching partnerships with Managed Care Organizations by implementing inventive initiatives and exploring alternative payment models.
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Value of Community-Based Hospice Care
Community-based hospice services play a crucial role in averting avoidable trips to the emergency room and hospital stays through proactive measures to anticipate, mitigate, and alleviate suffering stemming from severe illnesses or deteriorating health conditions. Moreover, they excel in recognizing and mitigating non-medical social determinants of health, which substantially influence patient well-being and the identification of critical risk factors necessitating hospitalization.
The cornerstone of community-based hospice care lies in advance care planning facilitated by expert hospice clinicians. These professionals possess specialized training and adeptness in conducting intentional and profound discussions regarding disease progression comprehension. They also skillfully explore the nuances of treatment burdens and benefits, alongside establishing adaptable goals throughout the care journey.
A study to assess the value of hospice to the Medicare program and to beneficiaries, their families, and caregivers published by NORC at the University of Chicago revealed the following:
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Medicare beneficiaries using hospice care experienced $3.5 billion less in total costs in their last year of life compared to non-users, equating to a 3.1% reduction in costs.
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Hospice care employs a person-and-family-centered bundled payment model, which helps avoid expensive and unwanted treatments during the end-of-life phase.
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Policies advocating for earlier enrollment and extended stays in hospice have the potential to further decrease Medicare spending.
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Despite the overall benefits of hospice care, the median length of stay is short, with over a quarter of patients enrolling only in the last week of life.
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Longer hospice stays, particularly those lasting over six months, offer significant value to Medicare, including for patients with terminal neurological conditions.
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Research indicates that despite concerns about prolonged hospice stays, those exceeding 180 days continue to improve quality of life and care while reducing spending.
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Hospice admission within the last six months of life is associated with increased patient satisfaction, improved pain management, fewer hospitalizations, and reduced in-hospital deaths, underscoring its advantages for patients and their families facing various terminal illnesses.
Network Hospice Standards
WVHPCN maintains a high-level of care through adherence to certain standards.
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Eligibility criteria that consider a patient’s illness, terminal health status, quality of life, and/or care needs
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Timely referral and admission
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Timely symptom management
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Development of a comprehensive care plan that addresses key needs
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Improved symptom management that reduces unnecessary spending
Network Hospice Metrics
WVHPCN collects and evaluates certain data metrics to improve patient management.
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Recognition of patient appropriateness and transitions of care
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Identification of partners and educational opportunities
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Overall utilization of services
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Identifying and reducing unnecessary care
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Advance Care Planning for patient and family satisfaction
Partner with WVHPCN to better manage your seriously ill plan members
Hospice care, through a collaborative effort between health plans and providers, effectively minimizes unnecessary expenses for patients who are anticipated to incur significant costs. This collaborative approach enhances symptom management and service provision thereby preventing the need for higher-cost institutional care settings and optimizing the utilization of resources.
That’s why WVHPCN is always looking to expand its partnerships with health plans who seek to provide seriously ill patients with a better health care experience. If you are a West Virginia health plan interested in learning more about the network and potentially contracting with hospice providers, we encourage you to contact us today!