Community-Based Palliative Care

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."