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

In Part One of this thought-provoking conversation, Chris Comeaux and Robin Heffernan, PhD, Co-Founder and CEO of Empassion, explore the evolving intersection of private equity, artificial intelligence, and end-of-life care—raising critical questions about accountability, quality, and the future of hospice under Medicare Advantage.

As the healthcare system shifts toward value-based models, the discussion challenges long-held assumptions about whether hospice should remain “carved out” or be fully integrated into payer responsibility.

Robin offers a systems-level perspective, arguing that aligning financial accountability across the entire patient journey—including end-of-life care—could drive better outcomes, reduce fragmentation, and elevate hospice quality.  At the same time, Chris voices the concerns shared by many hospice leaders: issues of trust, the deeply human nature of end-of-life decisions, and the risk of reducing care to cost-containment mechanisms.

Together, they unpack the real tension facing healthcare leaders today—how to preserve the holistic, compassionate ethos of hospice while navigating economic realities, emerging AI capabilities, and increasing private equity influence.  This episode invites listeners to think critically about what must change—and what must be protected—as the future of serious illness care takes shape.

Key Takeaways

• Alignment drives accountability:  Integrating hospice into Medicare Advantage could incentivize payers to prioritize quality outcomes across the full continuum of care—not just upstream services.
• Quality vs. access tension:  Without strong network design, “carve-in” models risk perpetuating low-quality providers rather than elevating high-performing hospice organizations.
• The economics are shifting:  Value-based and capitated models may ultimately reward high-quality hospice providers more than traditional fee-for-service structures.
• AI will expand early intervention:  Predictive analytics and lower-cost engagement tools could identify patients earlier and broaden access to palliative care conversations.
• Trust remains the central challenge:  End-of-life care is fundamentally different—patients and families must trust that decisions are guided by care, not cost.
  
  

If this conversation challenged your thinking, don’t stop here.  Share this episode with a colleague, reflect on how these shifts impact your organization, and join the dialogue shaping the future of end-of-life care.  Be sure to subscribe so you don’t miss upcoming episodes that continue to explore leadership, innovation, and purpose in healthcare.

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