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Setting you up for
The Centers for Medicare & Medicaid Services’ Primary Care First (PCF) model is rolling out in 2020, and applications will be available in the coming weeks. The Seriously Ill Population (SIP) model under PCF is designed to improve care for high-need, high-risk patients who currently receive fragmented or inadequate care. To do this, CMS will assign SIP patients to participating hospice programs, paying the providers to coordinate their care and avoid unnecessary hospitalizations.
There are numerous benefits to hospices participating in the SIP program, so don’t let the application process be an obstacle to getting involved. Wise Hospice Options is offering SIP eligibility and readiness assessments to determine if SIP is a good fit for your hospice, identify any obstacles to being approved for participation, and help you build financial and operational models that help ensure your success in the program. Wise Hospice Option’s assessment is comprehensive, and is designed to put your hospice in a position to thrive as payment models continue to change.
While the application has not been released yet, because Primary Care First is based on CPC+, the applications are likely to be similar. As with all Alternative Payment Model (APM) applications, it will likely feature a combination of check boxes and narrative answers about your organization, asking how you’ll meet the eligibility requirements and drive success in the program.
Any hospice who undergoes a SIP assessment with Wise Hospice Options will receive templated responses for the narrative sections. Offering templated responses saves you time when applying. Wise Hospice Option’s team includes experts on APMs who have worked with similar applications for years, and together, they’ve crafted responses that increase chances of approval based on their own experience with CMS.
Although CMS has not announced what types of patient information will be available to participating hospices — which will likely come once the application is approved but before signing the participation agreement — Wise Hospice Options is prepared to make sense of that data. Our team of health economists and data scientists can analyze the files from CMS and provide a glimpse into what 2020 will look like for your hospice, specifically estimates of the number of patients being assigned to you, their acuity, their prognosis, and more.
Hospices already employ a multidisciplinary staff to meet patients’ needs. Wise Hospice Options will provide incremental staffing models to ensure you can plan for staffing adjustments required to meet the demands of the SIP program. Robust financial modeling takes into account these needs and allows you to predict revenues, costs, and margin earned from participation. Hospice’s should be able to earn at least 20 to 25% net profit margins caring for SIP patients.
To participate in the SIP program, CMS requires a hospice to make use of technology to support care delivery. From certified EHR platforms, to Health Information Exchanges (HIEs), to analytics capabilities, hospices will need to prove to CMS that they are able to make data-driven decisions about a population. Most hospices have never faced this requirement before and may find themselves without a clear path to success. Acclivity will assess your technology infrastructure to identify and help resolve any gaps that exist.
Hospices in the SIP program must prove they have a network of providers in the community that can help meet the needs of their patients. While many hospices already offer care coordination, Wise Hospice Options can help you conduct successful, relationship-building conversations with other providers in the community to ensure patients have access to the right care, at the right time, in the right place.
With the hospice carve-in looming, hospices need to start thinking about how they will interact with Medicare Advantage payers. SIP is a great first step. Because CMS has made PCF and SIP a multi-payer model, Medicare Advantage payers are invited to participate. The Wise Hospice Options team has decades of experience working with these payers and can help your hospice hold meaningful discussions about how you partner with them on SIP. Even though the Medicare Advantage payers’ version of the SIP program will be similar to CMS’s, there will be differences and you’ll need a plan about how you negotiate the details.
Wise Hospice Options and our partners are well-versed in CMS Alternative Payment Models as well as the unique needs of hospice organizations, creating a strong knowledge base not available anywhere else. Additionally, Wise Hospice Options supports many hospices nationally, all of whom have varied experiences and are willing to share insight and best practices. Hospices who wish to learn from each other can be connected within our network and share knowledge.
Once accepted into the SIP program, Wise Hospice Option’s data-driven platform provides ongoing support to hospices who want to succeed in the program.
For more information please call 800.856.9757 or email email@example.com to request a SIP Assessment or learn more about how Wise Hospice Options can help prepare you for the SIP program.
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