Date of Publication
1-29-2025
Abstract
Background: Palliative care (PC) provides a mix of comfort care and curative treatment to increase longevity while maintaining quality of life (QOL). In contrast to hospice services, few Medicaid programs reimburse for PC. The Department of Vermont Health Access (DVHA) reimburses institutional and home-based PC (HBPC) for pediatric beneficiaries, but only institutional PC for adults. The project goal is to identify provider reimbursement perspectives and models. Methods: We conducted literature reviews, and reviewed reimbursement models for palliative care coverage for California, Hawaii, and Washington. We drafted Interview scripts specific to Vermont. Thirty-minute interviews were conducted with three expert medical providers and representatives from two home healthcare providers via video conference calls. Analysis was performed through NVivo software (version 14), and common themes were identified. Results: Model, Care, Home, Reimbursement, Visit, Nurse, Palliative, Patients, and Providers were themes. Consensus was that HBPC is viewed favorably, and patients would benefit from expanded utilization. A per-member-per-unit-time, or capitated reimbursement plan was preferred due to incentivization of appropriate levels of care as well as preventative care. Challenges regarding care access were universal concerns, with lack of home-based staff and insurance coverage as the greatest concerns, along with obstacles inherent in a fee-for-service model when patients have varied needs. Conclusion: A capitated reimbursement model was noted as an option for effective and accessible HBPC services for Vermonters. A per-member-per-month (PMPM) model was proposed as the preferred reimbursement time scale to ensure that home health agencies administering HBPC are reimbursed fairly while meeting Vermonters’ healthcare needs.
Advisor(s)
Shamima Khan, MBA, PhD
Larner College of Medicine
Linda Martinez, RN, CPC
Department of Vermont Health Access
Marietta Scholten, MD, FAAFP
Department of Vermont Health Access
Agency
Department of Vermont Health Access
Subjects
Health Care Access and Quality, Health Insurance
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License
Recommended Citation
Cullen, Elliot; Murray, Petergaye; Mercier, Abigail; Gorbacheva, Anna; Reigle, Jake; and Peters, Kevin, "Assessing Palliative Care Reimbursement Models through Vermont Medicaid" (2025). Public Health Projects, 2008-present. 333.
https://scholarworks.uvm.edu/comphp_gallery/333
