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Humana Begins Coverage of Hospice Services as Part of Medicare Demonstration

Humana offering hospice benefit to Medicare Advantage members on select plans in five markets

Humana Inc. (NYSE: HUM) has begun evaluating a new way of offering hospice services to members of select Medicare Advantage plans in an attempt to provide greater continuity of care, additional transitional services and access to palliative support for patients with advanced illness.

As part of a four-year demonstration created by the U.S. Centers for Medicare & Medicaid Services (CMS), Humana’s program is intended to help the company and CMS learn whether hospice services provided within the Part A benefits package of Medicare results in additional innovation, enables a more seamless care continuum and improves quality and timely access to palliative and hospice care. Humana started offering the new benefit on select plans on January 1, 2021, in order to ease care transitions and ensure hospice-eligible patients who need it can receive the full benefits of hospice care.

Humana is offering the hospice benefit to Medicare Advantage (MA) members enrolled in certain MA plans in Atlanta, Cleveland, Denver, the Louisville, Ky., metro area (including Southern Indiana), and the Richmond-Tidewater region of Virginia. While hundreds of hospice providers are supporting the delivery of the hospice benefit, Humana has contracted with a preferred network of providers that are partnering on the delivery of additional benefits to support members during their hospice care.

“Humana is committed to what we call human care, part of which is simplifying the health care experience for all of our members,” said Susan Diamond, President of Humana’s Home business. “This means removing barriers to the care they need at all stages of their lives and eliminating financial and coverage surprises.”

“Too often, patients electing hospice care do so in the final days or weeks of life, rather than at the start of their eligibility. As a result, they and their families miss an opportunity to take full advantage of a wide range of benefits, including improved access to palliative care and caregiver support, as well as important transitional care services. Our goal is to allow for a single continuous care team, as opposed to the handoffs that typically occur today,” Diamond added.

As it stands now, when a patient with advanced illness who is receiving palliative care elects hospice, they move to a new care team based on the hospice provider selected. Under the demonstration model, Humana hopes to create continuity as members transition from advanced illness to palliative to hospice, ideally with the support of the same care team.

Patients electing hospice under fee-for-service coverage today have to forego all curative, transitional concurrent care, whereas the demonstration allows for transitional care to eliminate such an abrupt end to this care and provide greater access to the many additional benefits provided under hospice services. “We recognize the burden families often face at this time and are providing additional respite services to caregivers, allowing patients to remain safely in their home,” Diamond said.

The model also is designed to lengthen the time members are enrolled in hospice care, allowing them to remain in their home and avoid costly and often unnecessary hospitalizations near the end of life. More time in hospice means they and their families/caregivers can make full use of services that focus on their wishes and which include alleviation of pain, bereavement planning, respite care, spiritual matters, and other services. Under CMS guidelines, hospice benefits can last up to six months, but they can be continued indefinitely if the patient’s condition remains terminal.

Humana has created a web page for health care providers to explain the pilot program in detail, along with a list of the specific plans and markets where the pilot is running, at Medicare Hospice Value-Based Insurance Design (VBID) - Humana.

The demonstration continues through 2024, and Humana plans to expand the demonstration in 2022 to reach more members, pending approval from CMS in their annual application process.

About Humana
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

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Cary B. Willis
Humana Corporate Communications
(502) 905-5860

Source: Humana Inc.

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