Understanding the VBID model

The Centers for Medicare & Medicaid Services (CMS) recently launched a demonstration under the Value-Based Insurance Design (VBID) model with the goal to assess and improve patients’ experience using the hospice benefits within their Medicare Part A benefits package. This demonstration works to improve care through greater care coordination and reduced fragmentation.

Humana has been participating in this demonstration program on select plans since January 1, 2021. Our goal is to ease care transitions and ensure hospice-eligible patients can access and receive the full benefits of hospice care.

About Humana’s Hospice VBID model

Humana’s Hospice VBID model focuses on creating better continuity for our members who are moving from their Medicare Advantage experience and into end-of-life care via hospice.

Humana partners with VBID-specific Palliative Care providers to identify and support members who may benefit from a palliative care program in tandem with their Medicare Advantage plan coverage.

Humana’s Hospice Value-Based Insurance Design (VBID) model

Humana’s Hospice VBID model focuses on creating better continuity for our members between their MA experience and end-of-life care receiving hospice. Palliative care may be elected, which leads to the member entering hospice. In-network benefits start with transitional concurrent care, which can be elected; then in-home respite care along with an assistance allowance for hospice care. Next, hospice care is provided for the member and after a member passes away, bereavement care is provided to family members.*

*The hospice benefit under CMS remains the same for these components.

2022 Humana Hospice VBID—participating plans

Location Medicare Plan County Service Areas Plan/Option Atlanta, GA Humana Gold Plus® H4141-015-000 (HMO) Clayton, DeKalb, Fulton, Gwinnett, Henry 076/938 Atlanta, GA HumanaChoice® H5216-073-000 (PPO) Bartow, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Floyd, Forsyth, Fulton, Gwinnett, Haralson, Henry, Meriwether, Newton, Paulding, Pickens, Rockdale, Walton 079/424 Atlanta, GA HumanaChoice® H5216-071-000 (PPO) Cobb, Douglas, Paulding 079/422 Atlanta, GA HumanaChoice® H5216-143-000 (PPO) (PPO) Barrow, Forsyth, Gwinnett, Hall, Jackson 079/701 Atlanta, GA Humana Care Extra Care H5216-239-000 (PPO) Cherokee, Cobb, DeKalb, Douglas, Fulton, Gwinnett, Paulding 079/818 Cleveland, OH Humana Cleveland Clinic Preferred H6622-023-000 (HMO) Cuyahoga, Lake, Lorain, Medina, Stark, Summit 076/165 Denver, CO Humana Gold Plus® H0028-025-001 (HMO) Adams, Arapahoe, Broomfield, Denver, Douglas, Jefferson 076/209 Denver, CO Humana Gold Plus® H0028-025-002 (HMO) Boulder, Clear Creek, El Paso, Elbert, Fremont, Larimer, Pueblo, Teller, Weld 076/218 Denver, CO Humana Gold Plus® H0028-047-000 (HMO) Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, El Paso, Elbert, Fremont, Jefferson, Larimer, Pueblo, Teller, Weld 076/329 Green Bay, WI Humana Gold Plus® H6622-001-000 (HMO) Brown, Calumet, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marathon, Marinette, Marquette, Oconto, Outagamie, Shawano, Waupaca, Waushara, Winnebago 076/460 Louisville, KY HumanaChoice® H5216-018-000 (PPO) KY: Bullitt, Hardin, Henry, Jefferson, Marion, Nelson, Oldham, Shelby, Spencer

IN: Clark, Floyd, Harrison
079/260
Louisville, KY Humana Gold Plus® H5619-073-000 (HMO) KY: Bullitt, Hardin, Henry, Jefferson, Larue, Meade, Nelson, Oldham, Shelby, Spencer

IN: Clark, Floyd, Harrison
076/128
Louisville, KY HumanaChoice® H5216-019-000 (PPO) KY: Anderson, Bath, Bourbon, Boyle, Bullitt, Clark, Fayette, Franklin, Hardin, Henry, Jackson, Jefferson, Jessamine, Lincoln, Madison, Marion, Menifee, Montgomery, Nelson, Oldham, Powell, Scott, Shelby, Spencer, Woodford

IN: Clark, Floyd, Harrison
079/261
Richmond/Tidewater, VA Humana Gold Plus® H6622-004-000 (HMO) Chesterfield, Colonial Heights City, Dinwiddie, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City 076/897 Richmond/Tidewater, VA Humana Gold Plus® H6622-005-000 (HMO) Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Suffolk City, Virginia Beach City 076/898 Richmond/Tidewater, VA HumanaChoice® H5216-266-000 (PPO) Chesapeake City, Chesterfield, Colonial Heights City, Dinwiddie, Hampton City, Hanover, Henrico, Hopewell City, Newport News City, Norfolk City, Petersburg City, Portsmouth City, Richmond City, Suffolk City, Virginia Beach City 079/866 Richmond/Tidewater, VA HumanaChoice® H5216-144-000 (PPO) Amelia, Caroline, Chesapeake City, Chesterfield, Colonial Heights City, Cumberland, Dinwiddie, Franklin City, Gloucester, Goochland, Hampton City, Hanover, Henrico, Hopewell City, Isle of Wight, James City, King and Queen, Louisa, New Kent, Newport News City, Norfolk City, Petersburg City, Poquoson City, Portsmouth City, Powhatan, Prince George, Richmond City, Southampton, Suffolk City, Surry, Sussex, Virginia Beach City, Williamsburg City, York 079/702 Richmond/Tidewater, VA Humana Gold Plus® H5619-139-001 (HMO) Amelia, Charles City, Goochland, Louisa, New Kent, Powhatan, Prince George 076/565 Richmond/Tidewater, VA Humana Gold Plus® H5619-139-002 (HMO) Chesterfield, Colonial Heights City, Dinwiddie, Hanover, Henrico, Hoewell City, Petersburg City, Richmond City 076/566 Richmond/Tidewater, VA Humana Gold Plus® H5619-140-001 (HMO) Isle of Wight, James City, Poquoson City, Williamsburg City, York 076/567 Richmond/Tidewater, VA Humana Gold Plus® H5619-140-002 (HMO) Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Suffolk City, Virginia Beach City 076/568
Operational guidelines for in-network providers Operational guidelines for out-of-network providers Transitional concurrent care coverage

To become an in-network provider with Humana for hospice VBID, the appropriate contract must be executed and the required credentialing completed. All other providers servicing Humana eligible plan members in the participating regional markets will have an Out-of-Network status.

This guidance is for hospice providers serving participating members in the Humana hospice VBID. The aims of the Hospice Value-Based Insurance Design (VBID) Model Demonstration are to:

  • Ease care transitions and ensure that hospice-eligible enrollees do not need to choose between curative or hospice care when considering hospice election
  • Improve quality and timely access to the Medicare hospice benefit
  • Provide the full scope of hospice benefits, as defined in the Social Security Act (Section 1861 dd).
  • Improve hospice utilization patterns and costs of care related and unrelated to the terminal condition, based on improving the coordination and quality of care and service delivery
  • Enable enrollees, their families and caregivers to experience the benefits of hospice care over a more appropriate period of time as aligned with their wishes and the member’s needs
  • Create an opportunity to provide additional support and value to hospice enrollees through the use of supplemental benefits with in-network hospice provider election

Humana Hospice VBID operational guidelines for in-network providers, PDF

Hospice care assistance allowance benefit community resource directory for in-network providers, PDF

Palliative care guidelines, PDF

DispatchHealth provider flyer, PDF

In-network hospice provider training video

This guidance is for hospice providers serving participating members in the Humana hospice VBID. The aims of Hospice VBID model demonstration are to:

  • Ease care transitions and ensure that hospice-eligible enrollees do not need to choose between curative or hospice care when considering hospice election.
  • Provide the full scope of hospice benefits, as defined in the Social Security Act (Section 1861 dd).
  • Improve hospice utilization patterns and costs of care related and unrelated to the terminal condition and related conditions based on improving the coordination and quality of care and service delivery.
  • Enable enrollees, their families and caregivers to experience the benefits of hospice care over a more appropriate period of time as aligned with their wishes and the member’s needs.

Humana Hospice VBID operational guidelines for out-of-network providers, PDF

Palliative care guidelines , PDF

DispatchHealth provider flyer , PDF

Transitional Concurrent Care is the provision of curative care for a terminal condition for a member participating in the Value-Based Insurance Design model. Unlike the traditional hospice benefit, which focuses on non-curative care, transitional concurrent care includes all items or services that are part of the member’s plan of care with an existing provider as a result of the terminal diagnosis. Services may include but are not limited to, specialist provider visits, internist/PCP visits, access to specialized Durable Medical Equipment, and treatments for a variety of chronic and acute conditions.

The purpose of this addendum is to notify the Medicare beneficiary (or representative), in writing, of those conditions, items, services, and drugs that are covered under the Transitional Concurrent Care model by Humana.

Transitional Concurrent Care Process Flow for INN Providers, PDF

Humana’s Election Statement Addendum: Transitional Concurrent Care Coverage Form for In-Network Providers, PDF