Helios CEO: Be Ready for Value-Based Hospice Care

Helios Care CEO Dan Ayres is positioning his organization to hit the ground running in a value-based payment environment, prioritizing service diversification, payer and referral partner relationships and gathering the data needed to sell Helios’ value proposition as a provider of hospice and serious illness care.

Ayres took the helm of Catskill Area Hospice and Palliative Care in 2016 after working most of his career in the c-suite of hospitals. Earlier this year, the company rebranded as Helios Care to reflect its growing portfolio of services. The company cares for about 110 patients in three counties in largely rural segments of New York state. 

Hospice News caught up with Ayres by phone to discuss how his organization is adapting to the changing marketplace and what that indicates for the industry at large.

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Let’s talk about your rebranding. What motivated the change and what’s behind it?

There were basically three reasons for us wanting to rebrand. The first reason: More and more evidence shows that the word “hospice” has become a deterrent to referrals and accepting of the service. It has a connotation of the very end of life, as in days not weeks, and average length of stay up until recently for patients who died on hospice was 17 days — fairly short.

I think all hospices suffer from that dilemma. We get the patients on service, but the length of stay is so short. We find that even for families who have had positive experiences with hospice, the name itself invoked feelings of sadness and loss. So the name itself can be a deterrent.

Secondly, we see that our agency has to move further and further into the post-acute care space.We want to introduce ourselves in new services to patients with chronic disease symptoms earlier in their disease progression, so that when the time comes the transition from in-home palliative care or other services, care coordination would be more seamless to the patient. It’s a more natural progression from one one stage of the continuum of care to the next.

Thirdly, our name, Catskill Hospice & Palliative Care is a misnomer in our current situation, in that we only have one of the counties we serve located in the Catskills. We also have an aspiration to grow our services into more counties, and therefore the geographic descriptor is also restrictive.

You have mentioned that you are adding new services to engage patients upstream. What are the services you are seeking to implement?

Our entire strategy has been to prepare for value-based purchasing, because we know that’s what the future is, rather than trying to hold on to the status quo.

We want to build our in-home palliative care program, which is also what basically the Seriously Ill Population demonstration model under [the Center for Medicare & Medicaid Innovation’s Primary Care First initiative] is going to want to promote.

We recently did a pilot for in-home palliative care for patients with chronic disease who had high utilization of acute care services. In that pilot, which lasted about a year, we had more than 70 patients. We were able to reduce their acute care utilization by 80%. We found we were actually able to reduce over time our expenses to provide that service by 35%. We also saw a 23% conversion of in-home palliative care patients to hospice care.

This is increasing our length of stay. The two metrics you really look at are census and length of stay. Our census has gone up by about 10%, and our length of stay has gone up from 17 to 23 days.

While the pilot was based on a fee-for-service model, we wanted to gain information and data about our actual costs without being at risk. Between the data that we have accumulated and the knowledge that we have gained through that pilot, we are now able to have discussions in a value-based purchasing environment. We can now show the value of the pre-hospice service that then would result in increased hospice utilization.

What do you see as your next steps as you move towards a value based purchasing environment?

A contract! The environment within our market isn’t as advanced as some other markets, and so there is less willingness to take on risk. From our perspective, we know what our risk is because we now know what our costs are. We know how much it costs to provide this service, and we know how to how to provide high-quality service at a lower cost.

We’re ready, but the market isn’t. I think that’s going to develop fairly rapidly during the next two years. As we keep pursuing agreements eventually we are going to to find someone who is willing to pay for the value proposition of in-home palliative care and a more appropriate transition of patients to hospice. We have also engaged with an artificial intelligence solution that once we were able to obtain claims data, we can actually predict the need for hospice and palliative care up to about a 95% accuracy within a year.

We can bring value to the patient, but the market is still not ready for this. Ultimately it’s going to be forced upon them, and when it’s forced upon them, we’re going to stand ready to be able to provide this service.

As hospice and palliative care move gradually towards a value-based care environment, what do you think the impact will be on the hospice at large?

I think it will improve. Just take a look at the demographics. Of course the population is aging nationally, but when I look at the demographics locally, right now 23% of the people in our region is already enrolled in Medicare. We’re in some of the most rapidly aging counties in [New York state], and 40% of the patient population in our region has more than one chronic disease.

We need to keep the cost low on these patients. If you were to take a look at the risk stratification of a payer, the upper 10% is all in chronic disease treatment and care. In a rural, remote environment like ours, our ability to get to the patient’s home is an advantage to the overall health care system. So as the payment goes towards capitalization and population health management, we become a valuable asset.

As the population ages, the chronic disease becomes more prevalent; then our services in the home and transferring to hospice becomes more and more valuable.

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