Why Network Adequacy Alone Is Not Enough in Serious Illness Care
For decades, network adequacy has served as the baseline metric for healthcare access. The premise is simple: ensure patients have reasonable access to the providers and services they need across geographic regions and clinical specialties.
How Health Plans Can Evaluate Quality in Serious Illness Care
In a recent article, we explored why health plans increasingly partner with specialized organizations to support members living with serious illness. From a purely operational standpoint, the rationale is clear: traditional healthcare infrastructure simply wasn’t built to scale the proactive symptom management, advance care planning, and longitudinal, cross-setting support these patients and their families require.
Why Health Plans Partner for Serious Illness Care Instead of Building It Alone
Serious illness management exposes critical gaps in traditional healthcare delivery — gaps that fee-for-service models were never designed to solve.
How to Choose Hospice Care: A Clinician’s Guide for Patients and Families
Recent coverage, including reporting from the Los Angeles Times, has highlighted a difficult truth: while many hospice providers deliver exceptional care, quality varies and it’s not always easy to tell the difference.
Op-Ed from Robin Heffernan | Not just California: A national hospice ‘Blue Book’ is needed to fight fraud
Congress has finally decided to wade into the deep waters of hospice fraud. That is a good thing. But what members need to know is that this problem is not new, and it is not confined to one state. What’s more, enforcement alone will not solve it — what is desperately needed is more prevention.
CMS Is Finally Tackling Hospice Fraud. The Next Step Is Actually Preventing It.
CMS is taking new steps to address hospice fraud through provider scoring and transparency. Robin Heffernan explains why real-time hospice quality data is needed to prevent harm before it occurs.
Why Disease-Based Care Falls Short for Patients with Serious Illness
Serious illness is a distinct clinical state with its own drivers of cost and utilization, but plans have historically kept these patients aligned to disease-based clinical programs. Now that serious illness management has emerged as a new category of care, plans should re-think disease-based program attribution and enable the transition of these patients to a serious illness manager as their functional status declines.
Hospice Fraud and Oversight: What Needs to Change
A recent investigation by CBS News uncovered hundreds of hospice providers in Los Angeles showing warning signs associated with potential fraud and abuse.
Why Community-Based Care is Key to Hospice Access and Equity
Community-based palliative and hospice care can improve access, build trust, and reduce disparities in serious illness care across diverse communities.
Rural Markets Are a Stress Test for Medicare Advantage. Palliative Care Is Part of the Answer.
Once a growth opportunity in Medicare Advantage, rural markets now quickly expose weaknesses in payer cost management capabilities. Palliative care, when designed and delivered thoughtfully, is one of the few care models structurally capable of stabilizing utilization in rural markets, where volatility is highest…