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.

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.

Serious illness management exposes critical gaps in traditional healthcare delivery — gaps that fee-for-service models were never designed to solve.

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.

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 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.