# Impact of the Medicare Advantage Hospice Carve-In on End-of-life Care Outcomes among Beneficiaries with Alzheimer's Disease and Related Dementia

> **NIH NIH P01** · BROWN UNIVERSITY · 2024 · $353,897

## Abstract

PROJECT SUMMARY
An increasing proportion of Medicare beneficiaries are enrolled in Medicare Advantage (MA), representing half
of enrollees in 2023. Until recently, the Medicare Hospice Benefit was carved out of the MA program, so MA
enrollees who needed hospice would receive that care through traditional Medicare. As of 2021, the Centers
for Medicare & Medicaid Services (CMS) started testing the inclusion of the Medicare Hospice Benefit through
the MA's Value-Based Insurance Design (VBID) Model. By 2023, 119 MA organizations were participating in
the Hospice Benefit Component across 806 counties. Also referred to as the MA hospice “carve-in”, this
constitutes a major change for the MA programs and the implications are not yet known. While the MA carve-in
will likely impact all beneficiaries, especially in areas with high MA penetration, there are particular concerns for
the quality of end-of-life care among vulnerable groups such as decedents with Alzheimer's disease and
related dementia (ADRD). Prior work has found that these beneficiaries are more likely to disenroll from
hospice after long enrollment periods than those without this diagnosis. If we are to improve the quality of end-
of-life care provided to Medicare beneficiaries with dementia, there is a critical need to assess the impact of the
MA hospice carve-in on end-of-life care outcomes. Our long-term goal is to improve the quality of end-of-life
care provided to persons with dementia. The overall objective of this application is to explore the
implementation of the hospice carve-in and assess its impact on various aspects of care delivery and end-of-
life care outcomes. Our central hypothesis is that the hospice carve-in represents a profound change in
incentives for providers and may worsen end-of-life care outcomes among beneficiaries with dementia. We
plan to accomplish the overall research objective by pursuing the following specific aims: 1) explore how MA
organizations and hospice providers have adapted to the MA hospice carve-in by gathering primary qualitative
data from carefully selected informants from specific markets, 2) determine the effect of being enrolled in an
MA plan participating in the VBID Hospice Benefit Component on end-of-life care outcomes for Medicare
beneficiaries with dementia, and finally 3) examine heterogeneity in the impact of the MA hospice carve-in on
hospice utilization and other indicators of quality of end-of-life care among MA beneficiaries with ADRD across
different cohorts of health care users, racial/ethnic groups, and MA plan and market characteristics. The
expected outcomes from this proposal include a stronger evidence base to inform policy decisions and
oversight of the MA Hospice Benefit Component, including a better understanding of national variation in how
MA organizations have been adapting to this new care model.

## Key facts

- **NIH application ID:** 10934971
- **Project number:** 2P01AG027296-16
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Emmanuelle Belanger
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $353,897
- **Award type:** 2
- **Project period:** 2007-09-15 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934971

## Citation

> US National Institutes of Health, RePORTER application 10934971, Impact of the Medicare Advantage Hospice Carve-In on End-of-life Care Outcomes among Beneficiaries with Alzheimer's Disease and Related Dementia (2P01AG027296-16). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10934971. Licensed CC0.

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