Hospice is in a state of flux. The industry is evolving with the changing health care landscape in terms of practice, payment models and the pervasive presence of technology. Hospices nationwide are leveraging technological advancement to improve their workflows, improve efficiency and enhance patient care.
Technologies such as predictive analytics, telemedicine systems, artificial intelligence and virtual reality are gradually changing the way hospice care is delivered.
“I am a firm believer in technology from the standpoint of it allows you to add another layer of care, whether that be telephonic, whether that be a centralized view of your charts, or being able to add on call center technology or data analytic technology to really understand what is going on with a patient’s illness and when they have the highest probability of exacerbation. Technology has a huge role to play in that,” Larry Graham, CEO and founder of Curo Health Services said at the Home Health Care News Summit conference in September.
Virtual reality systems, for example, are gaining ground in the areas of staff training as well as in direct patient care.
VITAS Healthcare is working with AT&T to develop therapies using 5G virtual reality technology to address chronic pain and anxiety among hospice patients.
More and more hospice providers, such as the Hospice of Southern Maine, are using virtual reality (VR) technology to train their staff. Working with Embodied Labs, Hospice of Southern Maine developed the “Clay Lab,” in which employees take on the role of Clay, a 66-year-old veteran with stage IV, incurable lung cancer.
As Clay, the participant receives news of the terminal diagnosis, has a fall that leads to a discussion of hospice care, and finally experiences his final days and the end of his life. Some of these activities are not part of the typical hospice worker’s job experience, but can help them understand more about the process as a whole.
“Virtual reality is going to be very powerful from a pain management perspective. We are already seeing it in clinical testing of the patient experience,” Nick Westfall, CEO of VITAS Healthcare, said at Summit. “It is extremely powerful, even in terms how you educate your workforce.”
Telemedicine is also becoming increasingly important in hospice care for communities nationwide, but the technology is making its biggest impact in rural areas where clinicians may have to travel significant distances to reach the patient or in areas that are not accessible to hospice or palliative care clinicians.
The University of Kansas Medical Center piloted the first telehospice service in 1998. That attempt encountered serious challenges due to costs and prevailing attitudes about technology at the time. A second project in 2017 found its footing, which the medical center launched in collaboration with Hospice Services and Palliative Care of Northwest Kansas, Inc..
Between Aug. 2017 and Jan. 2018 Hospice Services engaged in 218 telehospice video encounters involving 917 participants, including staff and patients. The program yielded significant cost savings for the hospice, and participants reported that the program strengthens communication and relationships among staff and patients and family, according to a study on the project published in February.
Aspire Health, a community-based palliative care provider about a year ago launched its telehealth palliative care service service for patients in rural areas that are too sparsely populated to support in-home clinician visits.
Aspire works with patients who are enrolled in Medicare Advantage, managed care Medicaid plans, and those who have traditional commercial health insurance. Their program is focused on the sickest 1% of patients who live in rural areas, Emily Cook, chief clinical operations officer for Aspire Health and affiliated primary care provider CareMore Health, told Hospice News.
Aspire identifies patients who can benefit from their telehealth palliative care services through referrals from physicians and case managers, as well as through analysis of claims data that looks for markers of advanced illness, complex comorbidities and/or increasing use of the health care system, such as hospitalizations.
A key goal of the program is to keep patients in their homes and out of the hospital, as well as supporting symptom management.
The program operates on an interdisciplinary team model that is led by social workers who are supported by registered nurses or nurse case managers and also by physicians who help when patients become symptomatic. They primarily work with patients via telephone, as the company has found that to be patients’ first preference among the age group Aspire typically serves, according to Cook.
“The purpose of the program is to help patients and families know what their choices are to, first, formulate what their goals of care might be according to their own values and how they want to navigate the last year or two or their lives, and what they want their lives to look like and what they want their health care to look like,” Cook said. “First and foremost it’s about giving patients informed choice so that they are the architects of their lives and of their health care, so our programs help build their confidence.”