Seriously Ill Patients, Temporary Solutions

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So Bloom did SO well in Quality that they earned even more in the “High Earners” pool for the highest achievers. That is paid by Quality losses by other entities, in case you were wondering!

(The other two in my snip did well, also, by the way!)

Value-based care skeptics out there—is this compelling?

Imagine if you had a population of patients in primary care and earned an additional $8,000 per beneficiary for the year?

For giving patients with serious illness better care and improving their quality of life!

So as of now, ACO REACH ends at the end of 2026. There are a host of possibilities for what comes next for REACH participants, but I would be surprised if the Standard and New Entrant participants didn’t have a “home.”

But the High Needs program is quite different from them.

They all do involve direct contracts and prospective payment mechanisms between CMS and providers, however.

Seriously Illness and Medicare Advantage

Whole-person care for the seriously ill in Medicare Advantage has been well ahead of Traditional Medicare for years.

Ex-CMMI Director (Under President Trump) Brad Smith sold his home-based palliative care company, Aspire Health, to Elevance. It’s now called Carelon Health. Here’s a short video on their site. 

He most recently launched Main Street Health to bring value-base care to rural America.

Brad Smith’s Aspire entered into value-based relationships with health plans to provide home-based palliative care to its members. It’s the right thing to do, AND if done well, it uses funding that would have gone to inpatient, reactive inpatient care to keep patients well-managed and home.

Oh, and President-elect Trump just appointed Brad Smith to a role at DOGE.

So what’s the point of all this?

There’s a finite amount of money that we all fund as taxpayers, employers fund in employer-sponsored plans, and that individuals fund when they purchase insurance on their own. We should use it in ways that improve care and because of that improved care, improve health outcomes.

Providers of all kinds complain about the budget-neutral Physician Fee Schedule cutting the conversion factor year after year to maintain that budget because of the volume and type of utilization of PFS services.

If we could avoid and/or prevent some hospitalizations in the last stage of life, if all patients with serious illness had access to programs like the High Needs ACO REACH program, if patients felt better because their symptoms and condition were controlled and stabilized, what would that mean?

I dream about that.

I know we can get there.