New Strategic Opportunities for Hospice

On Tuesday, March 8, Medicare announced a new five-year initiative that has the potential to radically change the way it pays for outpatient drugs. This is just another part of CMS’ ongoing migration of provider incentives from volume to value. These changes are already altering the landscape for hospices and their relationships with professional referral sources, including hospitals, health systems, physicians and ACOs.

Healthcare payment reform is creating a new set of challenges and opportunities for hospitals and health systems. This seminar will help the hospice administrator evaluate opportunities to become an active partner with hospitals, Accountable Care Organizations (ACOs) and other at-risk organizations in your market. In this session, you’ll gain clarity and a sense of direction for your organization’s strategies by learning from the perspective of three speakers: a hospice strategist, a hospice provider, and an ACO physician and owner.

Are you comfortable that you understand all the implications for your hospice?

In April, at the NHPCO Management and Leadership Conference, Sue Lyn Schramm, M.A., Director of NHPCO Edge, will be leading a half-day preconference session on the topic of hospice strategies for working with ACOs. Taking Hospice Skills Upstream: New Ways Hospice Can Partner with Health Systems and ACO’s is being presented on Wednesday, April 20, 9:00am - 12:00pm and online registration is open until March 31, 2016.

Of additional interest, attendees may want to consider combining attendance at this cutting-edge preconference session with the 2^nd Annual Executive Business Summit, Beyond the Benefit: Delivering on the triple aim in healthcare through palliative care, happening April 20 from 5:00 - 6:00pm (separate registration is required.)

Sue Lynn Schramm, MA
NHPCO Director, Consulting Services

See Sue Lyn Schramm's article in Spring 2016 NewsLine on ACOs and Alternative Payment Models.

Tuckson and Schumacher Talk about Changing Healthcare Marketplace

In anticipation of Dr. Reed Tuckson's keynote address at NHPCO's upcoming annual Management and Leadership Conference, "Leading through the Currents of Change" (April 21 - 23, 2016), he spoke with Don Schumacher about some factors that may serve the hospice and palliative care community as it integrates more fully with the nation's medical care delivery system.

Dr. Tuckson emphasized that the time is right or palliative and hospice care to be an essential component of the modern delivery system in the U.S. Medical care delivery is moving from volume-based to value-based, and quality issues - including care settings - are becoming increasingly important to all providers. Hospice and palliative care are well positioned and to add to the changes in care delivery. "If there is ever a time for this field to blossom this is the time," said Dr. Tuckson.

Key points from their discussion
Hospice and palliative care meet the needs and values of the patients they serve and represent better coordination of care. Additionally, the movement towards team based care - which is integral to the hospice and palliative care model - are becoming increasingly important. 

We are seeing the move to whole patient-centered care and hospice and palliative care bring dignity, respect and control to patients and family caregivers.

In recent years there have been many changes in the healthcare delivery system, much because of the Affordable Care Act. There is awareness of the need to be more effective further upstream. Dr. Tuckson spoke of his interactions with people across the country and said he is learning that people need a lot of support in understanding and engaging on related end-of-life issues. Making wishes known and engaging in advance care planning is, ultimately, a positive step for patients and their families. Providers need to create a fertile environment for such conversations and ensure that the appropriate tools have been developed and are available.

The time is right to develop partnerships between community-based hospice and palliative care programs and hospitals and physician organizations, noted Dr. Tuckson. "The focus on value and patient satisfaction provides an entirely different incentive for partnership," he noted.

Dr. Tuckson spoke with Don via Skype.

There is much opportunity. The challenge is how do we translate vision into tangible practices.
Additional clips from their conversation are available online:

• Being Proactive
• The Importance of Partnerships
• Final Thoughts

Dr Tuckson will deliver the plenary session on Friday, April 22 as part of the Management and Leadership Conference. Registration for the conference, being held at the Gaylord National Harbor Resort & Convention Center in National Harbor, Maryland, is now open.

Reed Tuckson, MD, is the managing director of Tuckson Health Connections, LLC, a health and medical care consulting business that brings people and ideas together to promote optimal health outcomes and value through innovation and integration across the field. Previously, Dr. Tuckson enjoyed a long tenure as executive vice president and chief of medical affairs for UnitedHealth Group.

The Story of a Generation of AIDS Survivors

In the early years of the AIDS Pandemic, many hospices provided care to the dying when mainstream medical providers were not offering care out of fear of the many unknowns associated with HIV/AIDS. 

Reporter Erin Allday has written a moving account of a generation of people who have survived living with AIDs in San Francisco. Published this week by The San Francisco Chronicle, "Last Men Standing" includes a number of pieces that look at the Pandemic that defines a generation. They include: 

• an extensive articlea documentary film to be released April 8
• a documentary film to be released April 8
• and profiles of survivors. 

"They had the remarkable luck to survive AIDS, and the brutal misfortune to live on. They outlived an epidemic, but San Francisco’s AIDS survivors are still fighting for their lives," reads the introduction to the special project available online.  

 

In his article, Allday writes:  "Since 1981, when the first man succumbed to a disease that did not yet have a name, AIDS has taken more than 20,000 lives in San Francisco, most of them gay men, most of them decades too soon."

Near the conclusion of the article, readers are reminded, "In a life defined by a plague and measured in loss and pain, in fear and loneliness, sometimes it’s the smallest steps forward, the briefest moments of gratitude, that matter most. Waking up to the sunlight. Taking someone’s hand."

A brief description of the documentary film reads, "Surrounded by the ghosts of a generation lost to the AIDS epidemic, eight gay men search for meaning in a life they never expected to have." This is the San Francisco Chronicle’s first feature-length documentary, which will be released April 8 at the Castro Theatre in San Francisco.  A preview of "Last Man Standing" is available online.

This special report from The San Francisco Chronicle has received much attention on social media.

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.