By K.
Jeanne Dennis, MSW
Associate Consultant, NHPCO Edge
When the
winds of change in health care blew our way many of us in hospice cheered, our
time had come! Hospice was the one provider that was hitting the triple aim:
better quality of health for a population of patients, better health care and at
a lower cost. But are the health care providers and payers in our communities
flooding our phone lines and email boxes to partner with us, learn from us,
contract with us? In some cases perhaps, but mostly we are hidden in plain
site, fighting for a seat at the table (with ACOs, DSRIPs, Medicare Advantage
plans, PCMHs, etc.) What happened? Why is the hospice model of care not promoted
as the solution to the problem of improving quality of care and saving health
care dollars? Consider two reasons: Internal barriers and external competition.
Internal
Barriers:
- Unprecedented Changes in the core hospice business that require significant operational focus
and resource allocation.
- Funding:
with no distinct palliative care benefit, and the options of Medicare B and/or fund
raising lacking the promise of a breakeven bottom line, the financial case is
too hard to make.
- Infrastructure:
Although a community-based palliative care service is anchored in the hospice
model, it requires an investment in recruitment and education of staff, an EMR,
policies and procedures, a marketing plan, and more.
- Strategic
Positioning: with some notable exceptions, hospice programs did not have the
planning and palliative care program structure ready to go.
- Value
Proposition: participation in the new shared saving and risk sharing
opportunities demands data that demonstrates value. Pulling this information is
a challenge for many hospice providers.
External
Competition: The lack of distinct Medicare Conditions of Participation or a
benefit structure opened up the opportunity for palliative care innovation by
other providers and by payers. For example:
- Large
health care systems are already creating post-acute services designed to manage
patients in the community and reduce re-admissions
- Physician
groups (often part of a large system) are now expanding home visit and
tele-medicine services
- Major
health insurance companies are implementing care management programs with the ability
to scale beyond the usual boundaries of most hospice programs
- New
entrants in the field like Aspire Health, a for profit company founded in 2013,
now providing community based palliative care in 11 states and the District of
Columbia. Aspire has the advantage of a well-known Board Chair, Bill Frist, MD,
former Senate Majority Leader and $21m in venture capitalist funding.
The good
news is that it’s not too late to succeed. Community-based palliative care is
in our DNA, and the opportunity to shape the future of care for a vulnerable
population is now. The innovation in palliative care that’s happening among hospice
providers is encouraging and exciting. For hospice leaders this service is emerging
as a top strategic priority. Hospices are now taking action aimed at clearing
the barriers. Record-breaking attendance at NHPCO’s Palliative Care offerings
at the recent MLC is evidence of the energy and interest in adapting the
hospice principles, practices and proficiencies to meet the care needs in the community
and the mandates of the new value based payment models.
NHPCO is
committed to leading these efforts and NHPCO Edge is here to provide support
and consultation.
This post was written by K.
Jeanne Dennis, NHPCO Edge Associate Consultant. NHPCO Edge is proud to count
Jeanne among our expert consultants, as she brings decades of experience in
hospice leadership. For more info, see NHPCO Edge online.
See our previous NHPCO Edge blog, "Using Metrics for Marketing."
