Positioning for the Future of Community-based Palliative Care

“Community-based Palliative Care” is the new catchphrase in hospice and palliative care, causing many hospice and homecare providers to contemplate their related strategy. What’s clear is that this is not community-based care, as we’ve known it. Many of the new community-based models represent a paradigm shift in new ways to partner with payers and ACOs, develop reimbursement models away from fee for service billing, and identify novel means to grow their core hospice and palliative care businesses.

These evolving advanced illness management programs offer new ways to leverage hospice expertise. Early evidence points to significant improvements in cost and quality, while better meeting patient and families’ needs. Programs using population health strategies are putting in place a much-needed continuum of care for persons at risk for unwanted and medically unnecessary care. 

Community-based palliative care providers reduce the provision of non-beneficial care by proactively establishing goals of care conversations and improving patient and caregiver understanding of treatment options during the last years and months of life. Doing so is a win for both payers and patients alike. Some programs use predictive analytics to identify the “sickest of the sick”, thereby focusing care where it is needed the most and producing the greatest return on investment.

These new population health community-based approaches require hospice executives to develop new skill sets and a change in thinking about business development and strategic partnerships. This new skill set includes learning how to work with payers or ACOs, understanding the critical use of data for proactive patient selection; using risk stratification methods to guide care management strategies; and measuring clinical and financial outcomes to illustrate quality of care and return on investment.

Hospices choosing to sit on the sidelines that lack a strategy for dealing with these changes will be left behind. As NHPCO’s President and CEO Don Schumacher recently stated during a NHPCO Chat on the topic of community-based palliative care “A firmly developed continuum of services is exactly the kind of thing that every hospice should be moving themselves towards. Don’t wait… Be the resource in your community who people turn to for this.”

On April 20, we are hosting the 2^nd Annual Business Summit where you will have an opportunity to hear firsthand what payers and ACOs are looking for in their community-based partners and the metrics that matter to them the most. I believe this summit will be a valuable resource for hospice executives looking to build a community-based program as an extension of their current service lines. If you plan to attend NHPCO's Management and Leadership Conference, this is one event that you won’t want to miss! Please note, registration is required for the 2nd Annual Business Summit.

Terri Maxwell PhD, APRN
Chief Operating Officer
Turn-Key Health
www.Turn-KeyHealth.com

 

Look and Think Beyond Hospice

“There must be a commitment to more than simply introducing African Americans within your community to hospice. It’s more than numbers and larger than your organization. It is about social justice and ending healthcare disparities, and helping African Americans recognize that hospice truly helps the living. As you reach out, simply consider the big picture.” 

- NHPCO’s Inclusion and Access Toolbox 

As Black History Month comes to a close, take a look at the communities in which you serve. This month can serve as one of many opportunities to educate and engage African American patients, families and caregivers on the work we do but also, other healthcare initiatives and access goals. As recent as 2015, studies continue to show that African Americas are more likely to experience poor access to medical care compared to whites.  Thus, the NHPCO African American Outreach Guide recommends looking beyond hospice by recognizing disparities on a larger scale and considering more than the illness. 

Recognize disparities and remember history. The Outreach Guide notes, “Be mindful of the realities of treatment differences, healthcare disparities and basic historical experiences.”  

NIH MedilinePlus defines health disparities as the inequalities that occur in the provision of healthcare and access to healthcare across different racial, ethnic and socioeconomic groups. 

In 1906, W. E. B DuBois, a noted scholar, editor, and African American activist, published three studies that addressed demographic issues and concerns. One of these studies, The Health and Physique of the Negro American..., is known for recognizing health disparities very early in history.  African Americans and other minorities have experienced a long history of healthcare discrimination and inequalities. Although some progress has been made through the creation of special health institutes, programs and legislation to help combat these disparities, they still exist. A 2013 study in Journal of Palliative Medicine by Dr. Kimberly Johnson of Duke University’s School of Medicine indicates that among Medicare beneficiaries, 45.8 percent of whites used hospice care, compared with 34.0 percent of African-Americans.

The 2015 Keller Report: Health Disparities in America made note of other health disparities among African American communities: 

• Overall: African Americans have higher rates of mortality than any other racial or ethnic group for 8 of the top 10 causes of death.
•  Cancer: Rates for African Americans are 10% higher than those for Americans of European descent.
•  Diabetes: African American’s are nearly two times more likely to have diabetes as non-Hispanic whites.
•  HIV/AIDS: While Black/African Americans account for 13% of the total U.S. population, they account for almost half (46%) of all new HIV infections.
•  Kidney Disease: African Americans make up more than one third of all U.S. patients receiving dialysis for kidney failure despite representing only 13% of the overall U.S. population. 

The report goes on to say, inequities in health and health care in communities of color remain deep and persistent. These inequities span from the cradle to the grave, evidenced by higher rates of chronic disease and premature death. Though there are a number of challenges in addressing these disparities, there are equally as many opportunities for us to advance and achieve health equity. I could not agree more!

Another recommendation in the Outreach Guide is to consider more than the patient’s illness. Sometimes a patient’s illness is just one part of a bigger, highly complex family system.  Consider:  

• Who cares for the patient when healthcare professionals are not present?
•  Is the patient a caregiver? If so, who will take over that responsibility?
•  Is the patient’s home environment clean and safe?
•  Does the patient have running water?
•  Does the patient’s neighborhood pharmacy carry the prescriptions and medical supplies this patient needs?

It’s important to be prepared to deal with scenarios as described above.  These can be contributing factors to other “big picture” disparities that affect the patient, their illness and ability to access good quality care and services. Become familiar with local community organizations that you can refer patients and their families to such as Meals on Wheels, utility bill and rent assistance programs, your local Department of Community and Human Services, as well as, local health departments.  Don’t just refer. Be able to give a brief overview of some of the services these organizations can offer.

Many steps can be taken to assist individuals and communities with the information and resources they need to improve their health. Some recommendations and actions include

• Increase the cultural and communication competence of health care professionals 
• Hire and train more qualified staff from these underrepresented communities 
• Participant in community-led prevention programs 
• Improve health literacy through continued outreach  
• Build trust in these communities by having a community presence 
• Much more

Opening access to everyone in your community requires a commitment to inclusion and a strategic approach to meeting the specific needs of those in the communities you serve. For additional resources to help you improve access to end-of-life care through a variety of program development, education, outreach and marketing strategies, visit nhpco.org/access.

Cozzie King
NHPCO Senior Manager, Access Programs

Deadra Gladden, pictured with a niece, had the benefit of palliative care and then hospice care services.

JPM Releases Special Issue Focused on End-of-Life Care in the African American Community

We encourage those who are interested in learning more about end-of-life care in the African American community, to view and download the Journal of Palliative Medicine special issue, “Palliative and End-of-Life Care for African Americans.” The issue is available for free on the website until March 9, 2016.  

The issue commences with an editorial from Ronit Elk, PhD, “The First Step Is Recognizing, Acknowledging, and Respecting the Inequity, Disrespect, and Disregard Our African American Patients Have Experienced.”   One of the key points that Elk emphasizes, is the importance of religion and spirituality in the African American community. Throughout the issue, additional editorials, articles, brief reports and personal reflections mirror Elk’s emphasis on how faith should be included in advance care planning/end-of-life discussions. 

In the article, “What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?” Kimberly S. Johnson, Richard Payne, Maragatha N. Kuchibhatla, reviewed the tactics hospices in North and South Carolina use to increase access to hospice care in the African American community.  

Corey L. Kennard, founder and Pastor of KINGDOM equipping ministries, a Christian teaching fellowship, and the Kingdom Equipping Institute of Spiritual Development in Detroit, Michigan, authored the editorial “Undying Hope.”  In the piece he talks about a patient whose faith was the cornerstone of his life and who was very untrusting of physicians.  “George” finally saw a doctor at the age of 73 and it was then he was diagnosed with prostate cancer. His distrust of physicians continued because his physician did not ask him about his faith or how it would shape his end-of-life journey.  This omission left him very disappointed.   

There are many great pieces in the JPM special issue. NHPCO continues to share African American outreach resources during Black History Month but we are committed to carrying the message that “hospice helps everyone,” beyond the month of February.  Pastor Corey, mentioned above, will teach one of the courses being offered by Morgan State University and NHPCO during a new collaboration between the two organizations. The partnership aims to educate caregivers and equip them with information to make informed decisions about end-of-life care. To read more about this partnership, view NHPCO’s press release.  

Amanda Bow
NHPCO Director, Strategic Communications
 

 

See how hospice helped Willie and her family enjoy more special moments at the Moments of Life: Made Possible by Hospice website.

Executive Business Summit: Going Beyond the Medicare Hospice Benefit

Delivering on the triple aim in healthcare through provision of palliative care is focus of annual Executive Business Summit.

Helping hospice and palliative care executives strategically plan for the future through community-based palliative care resources and services is the theme of the second annual Executive Business Summit hosted by Enclara Pharmacia and Turn-Key Health in partnership with the National Hospice and Palliative Care Organization.

The summit, “Positioning for the Future,” will feature an interactive panel discussion exclusively designed for hospice and palliative care leaders to explore evolving trends in healthcare policy, payment models, and collaboration between payers, health systems, and care providers.

The summit will be held Wednesday, April 20, 2016, 5:00pm to 6:30pm, the evening before the official opening of NHPCO’s annual Management and Leadership Conference (MLC) at the Gaylord National Resort & Convention Center in National Harbor, MD.

Attendees will discover innovative ways to leverage existing palliative resources and staff to help foster organizational growth and build successful hospice and palliative care partnerships with payers and health systems.

“This summit will allow attendees to learn the value proposition of hospice and palliative care provision as it relates to cost and quality within the post-acute environment,” said Andy Horowitz, CEO of Enclara Pharmacia. “Ultimately, our goal in hosting the summit, is to better equip hospice and palliative care providers to improve patient care and control costs in patient populations with advanced illnesses.”

Nancy-Ann DeParle, founding partner of Consonance Capital Partners, and former deputy chief of staff for policy and director of the White House Office of Health Reform will serve as panel moderator.

Panel members are:  Jennifer Brokaw, MD, emergency physician and health care entrepreneur; J. Brian Cassel, PhD, palliative care research director, VCU School of Medicine; Torrie Fields, MPH, senior manager of advanced illness, Blue Shield of California; and Bruce Smith, MD, FACP, executive medical director, Cambia Palliative Care Services and Regence BlueShield.

This special event is offered free-of-charge to participants attending NHPCO's annual conference. The summit will be followed by a cocktail reception hosted by Enclara Pharmacia, Turn-Key Health, and NHPCO. 

Space for the Executive Business Summit is limited and registration for summit in addition to registration for the MLC is necessary. Potential attendees with questions can call NHPCO at 1-800-646-6460.