Health Insurers Offering Expanded Hospice Coverage

We recently saw a business note of a health insurer in Michigan offering expanded hospice coverage. Hospice care is a covered benefit under Medicare for patients with a prognosis of 6 months or less. (A patient can remain in hospice care beyond six months if a physician re-certifies that the patient is terminally ill.) Many private insurers offer a similar benefit. However, the average patient receives hospice service for less than 70 days*. Many providers believe people might be referred to hospice earlier if the coverage period were longer.

The Journal of Palliative Medicine published a comparative study looking at whether patients would increase their use of hospice when a health plan expanded benefits and made the care more accessible. The study looks at a trial program conducted by Aetna which offered:

. . . expanded insurance benefits for hospice care and added nurse case managers who provided information to patients and their families. The result was a dramatic increase in both overall hospice use and the mean number of days in hospice care. This study must be evaluated in the light of compelling research data over the past decade that shows hospice care provides better care than standard care for patients near the end of life. The percent of patients referred for hospice care and the number of days in hospice care are nationally accepted measures of quality health care. Claire M. Spettell from Aetna and colleagues conclude that more liberal hospice insurance benefits and the addition of comprehensive case management to a health plan can help lead to better health care for patients with advanced illnesses. The authors document about a 70% increase in hospice use in the article entitled, “A Comprehensive Case Management Program to Improve Palliative Care.”

^{* According to NHPCO's Facts and Figures on Hospice Care.}