Literature Review

Families demand end to Medicare waiting period for early-onset Alzheimer’s patients Washington Examiner; by Elaine Mallon; 6/15/25 Jason Raubach was diagnosed at 50 years old with early-onset Alzheimer’s disease — a diagnosis that affects nearly 200,000 Americans. He received the diagnosis in 2018, completely upending life for his family. His youngest child was just a freshman in high school. ... Shortly before receiving an official diagnosis, Jason Raubach lost his job, having to move his family onto a consolidated omnibus budget reconciliation act health plan, or COBRA plan, which allows a person to keep their health insurance even after losing their job. “It wasn’t cheap,” Elizabeth Raubach said.However, once diagnosed, Jason Raubach had to wait two and a half years before he could receive coverage under Medicare, health insurance for those 65 years and older or those with qualifying disabilities. But Elizabeth Raubach, along with dozens of other caretakers for people diagnosed with Alzheimer’s, called on Congress in a letter to eliminate the 29-month waiting period required for those under the age of 65 to receive coverage under Medicare. ...

CMS’ TEAM Payment Model: What hospices need to know Hospice News; by Jim Parker; 5/30/25 A forthcoming alternative payment model for hospitals focuses on discharge planning and ensuring effective post-acute care, including hospice and palliative care when appropriate. The U.S. Centers for Medicare & Medicaid Services (CMS) late last year unveiled its new Transforming Episode Accountability Model (TEAM). Participation in the model will be mandatory for select hospitals. The program is set to launch on Jan. 1, 2026 and run through Dec. 31, 2030. CMS designed the program based on lessons learned from previous episode-based payment models, as well as input from stakeholders in response to a Request for Information published in 2023.  

Care transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative programJournal of Palliative Medicine; Emily Jaffe, Emily Hobart, Alexandra Aiello, Amber Shergill, Amanda Harpster-Hagen, Tyson S. Barrett; 5/25This study describes a unique partnership between an insurer and a provider to enhance the quality, availability, and access to palliative services. A retrospective cohort analysis of insurance claims data for patients receiving palliative care compared to a matched cohort not receiving palliative care services from 2019 through 2022. Outcomes demonstrated a total savings of $4,526,408 through reductions in costs for the treatment group compared to the control group for total cost of care ...., inpatient stays ($5,672 ... ) , outpatient visits ($229 ... ), professional claims ($1,243 ... ), and pharmacy fills ($17 ... ). The treatment group had lower skilled nursing facility ($1,049 ... ) and inpatient rehabilitation facility ($216 ... ) costs. The treatment group had higher rates of hospice care (83.7% in the treatment compared to 50.2% ... ) but had lower lengths of stay (four days compared to five ... ).Conclusions: Collaborative investment in a palliative program by a payor and provider system shows significant financial savings for an insurer when patients receive evidence-based palliative care near the end of life.

Podcast: Innovations and insights in the palliative care space Holland & Knight; podcast by Daniel Patten and Spencer Freeman; 5/20/25 In this episode of "Counsel That Cares," Daniel Patten, a partner in Holland & Knight's Healthcare Regulatory & Enforcement Practice, and Spencer Freeman, chief strategy officer at Gentiva, discuss the challenges and opportunities that come with delivering integrated palliative care services, highlighting the lack of a defined Medicare benefit for palliative care compared to more established models such as hospice. Mr. Freeman shares insights on building care models that serve high-risk patient populations through coordinated interdisciplinary teams and data-driven approaches, emphasizing the importance of collaboration with risk-based primary care providers. Mr. Patten adds a legal perspective on the evolving landscape of value-based care contracts, artificial intelligence (AI) integration and regulatory compliance. Together, they explore how innovative programs can improve patient outcomes, reduce acute care utilization and facilitate payer relationships, offering a comprehensive view of the future of palliative care within value-based healthcare delivery.

Do automated reminders decrease no-show visits in an outpatient palliative medicine clinic? Sage Journals - American Journal of Hospice and Palliative Medicine; by Ruth L. Lagman, MD, MPH, MBA, Renato V. Samala, MD, MHPE, Ahed Makhoul, MD, Kyle Neale, DO, Chirag Patel, MD, Elizabeth Weinstein, MD, Wei Wei, MS, and Xiaoying Chen, MS; 3/23/25 Individuals who do not show up for medical appointments can lead to unfavorable outcomes for both patients and health systems. Automated methods are available to confirm appointments in addition to patient service coordinator (PSC) telephone calls. This study aims to determine the no-show rates for automated methods of confirmation, in-person and virtual visits, and patients living in underserved areas.Conclusion: PSC telephone calls, individuals living within COZ and virtual visits had higher no-show rates.

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.

CMS drops 5 proposed payment rules for 2026: 25 things to knowBecker's Hospital Review; by Alan Condon; 4/11/25 CMS has released proposed payment rules for inpatient and long-term care hospitals, hospices and inpatient rehabilitation, psychiatric and skilled nursing facilities in fiscal year 2026. Twenty-five things to know: ...

Health system CFOs fight for Medicaid on Capitol Hill Becker's Hospital Reivew; by Alan Condon; 3/31/25 Multiple health system CFOs recently traveled to Washington, D.C., to meet with lawmakers on Capitol Hill, advocating against proposed Medicaid cuts that could threaten access to care and lead to the closure of essential hospital services. Health system executives participating in these discussions included:

Charting the path forward to Value-Based Care Forbes; by David Snow, Jr.; 3/25/25 The U.S. healthcare system is at a crossroads, embarking on a crucial transformation in how care is financed. For decades, we've operated under a fee-for-service (FFS) model, which incentivizes service volume with little accountability for efficacy or costs. According to the Commonwealth Fund, this model contributes to poor healthcare access, lower care quality and lack of care continuity and is a factor behind the staggering per-capita healthcare costs in the U.S., which are the highest in the world. ... In recent years, we've seen a shift away from the FFS model to progressive value-based care (VBC) models that link provider payments to patient outcomes, care quality and cost efficiency. This is a fundamental overhaul of healthcare economics, and although it may be challenging and disruptive, I believe it's essential. [Continue reading ...]

Community health workers and technology interventions' impact on palliative support globally Journal of Palliative Medicine; by Alekhya Gunturi, Margarita Pertierra, Irma Elizabeth Huayanay Espinoza, Maya Kavita Ramachandran, Mpho Ratshikana Moloko, Karl A Lorenz; 3/20/25Background: Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings.  Conclusions: CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.Editor's note: Pair this with Hospice community responds to proposed DEA telehealth prescribing rule, posted 3/21/25.

Oz does not rule out Medicaid cuts during Senate confirmation hearing McKnights Home Care; by Adam Healy; 3/14/25 Mehmet Oz, MD, President Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services, did not give a direct answer when asked whether he was for or against Medicaid cuts Friday during a Senate Finance Committee hearing. “I cherish Medicaid and I’ve worked within the Medicaid environment quite extensively practicing at Columbia University,” Oz said when asked by Sen. Ron Wyden (D-OR) if he would oppose cuts to Medicaid. “I want to make sure that patients today and in the future have resources to protect them if they get ill. The way you protect Medicaid is by making sure it’s viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to actually use Medicaid.”

Pharmacies of the future: 4 keys to reinventionForbes; by Jenn Vande Zande; 3/11/25... “To continue to meet growing patient needs, we must evolve how community pharmacy works and, most importantly, how we support our pharmacy teams to create a sustainable future for community pharmacy,” Prem Shah, president of pharmacy and consumer wellness at CVS Health, said, referring to findings from the company’s Rx Report from January 2024. Based on those findings, CVS says there’s a “critical need for sustainable and scalable industry-wide change, such as operational improvements and digital innovations to better support pharmacy teams behind the counter.” Here are four focus areas for pharmacies to bring about that change: