Carve-In or Carve-Out? The Future of Hospice Under Medicare Advantage | Part Two

IIn Part Two of this thought-provoking conversation, Chris Comeaux and Robin Heffernan unpack the complex realities shaping the future of hospice under Medicare Advantage.

From the lessons learned in the VBID demonstration to the growing momentum behind “carve-in” models, this episode explores the tension between cost, quality, and patient experience—and what it will take to align all three.  At the center of the discussion is a critical question: how do we design a system that truly rewards high-quality care while eliminating inefficiencies and poor outcomes?

The conversation dives into emerging models like concurrent care “bridge pathways,” which challenge the traditional binary transition into hospice and offer a more patient-centered approach to serious illness care.

It also tackles the impact of private equity, consolidation, and payer incentives—raising important considerations about accountability, network design, and the sustainability of mission-driven providers.  For leaders navigating an evolving healthcare landscape, this episode provides both clarity and challenge on what comes next.

Key Takeaways

• The VBID demonstration revealed both promise and limitations—strong outcomes are possible, but only with better network control and quality alignment.
• “Concurrent care bridges” may offer a more realistic and compassionate transition into hospice, improving patient experience and outcomes.
• Financial incentives must shift toward total cost of care, not fragmented payment models, to truly drive better patient outcomes.
• Consolidation is likely, but high-quality providers—regardless of size—can still thrive if value and outcomes are prioritized.
• Payer accountability and earlier palliative care engagement are key to reducing costs while improving care quality.

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