Hospice Expected to Grow in 2020, Increase Focus on Social Determinants

The hospice space should see extensive growth during 2020 as well an increasing focus on social determinants of health.

Demographic tailwinds are among the drivers of hospice growth, as well as a driver of investment in hospice companies. An estimated 10,000 people in the United States become Medicare-eligible each day, a trend that many expect to continue until 2029, according to the Medicare Payment Advisory Commission (MedPAC).

“The opportunity for hospice care companies is immense. One of the most common things we hear in hospice is ‘I only wish we had this service sooner,’ and it’s imperative that providers leverage the continuum of care delivery available in the home with a focus on patient-centered care need,” said Kiersten Colovin, vice president of hospice for Interim HealthCare of the Upstate, a South Carolina-based Interim HealthCare franchise location.


More than 50% of Medicare decedents elected to enter hospice during 2018, a record number, according to the National Hospice & Palliative Care Organization (NHPCO). And more Americans are dying at home than in a hospital or other facility for the first time, as indicated by a report that appeared in the New England Journal of Medicine.

These factors come with both challenges and opportunities, such as the need to encounter patients earlier in the course of their illnesses.

“Providers must continuously explore ways to engage patients and caregivers throughout their health care journey. There are opportunities here for the health care community to raise awareness of what options exist for home care,” Angela Rhoads, vice president of Home Health and Hospice for Interim HealthCare, told Hospice News “We need to shift our thinking to align with the fact that our patients are becoming consumers of health care. That changes the way we interact, beginning with how we provide information about care in the home to how we provide care in the home. The expectations are changing, and this transition is coming much faster than change in the past.”


Interim HealthCare recently developed predictions for home health and hospice for 2020, including hospice growth, rising focus on social determinants, the fallout of ongoing staff shortages and other factors.

One consideration that impacts these changing expectations is the ascendance of millenials and members of Generation Z, who are rapidly becoming decision makers in the health care of aging parents and other family members. Hospices are already adapting their messaging, services and modes of communication to this changing landscape.

“Millennials and Gen Zers demand accessibility and care at their fingertips. No doubt, they will expect this as they assume care for their parents. They will be more informed, and they will do their research. Quality measures and consumer reviews will drive decision making versus general brand recognition,” Colovin told Hospice News. ”Offerings such as asynchronous communication through HIPAA compliant messaging and real-time monitoring through telehealth enabled devices allowing for oversight of a loved one’s care will certainly be a differentiator that will drive quality care and consumer satisfaction. Additionally, they will demand care beyond the traditional hospice benefit. This may include holistic, non-medical care interventions such as music therapy, meditation, acupuncture, essential oils, and so forth. It’s imperative that hospice and home care agencies stay abreast of these shifts in the market and integrate these types of innovative care initiatives into their service offerings.”

Exploring opportunities to provide nonmedical services, including complementary therapies and programs to address social determinants of health, can open new revenue streams for hospices, which currently rely on capitated per diem payments via the Medicare Hospice Benefit.

The U.S. Centers for Medicare & Medicaid Services (CMS) in 2019 announced that Medicare Advantage plans will begin covering supplemental nonmedical benefits in 2020. CMS will begin testing a Medicare Advantage carve-in for hospice in 2021, giving participating hospices access to those supplemental payments.

Many older adults and their families recognize that nonmedical help is necessary to maintain or improve their quality of life, but it can be overwhelming to seek out access to those services. This is where hospices can step in to offer support.

“The challenge here is engagement from all stakeholders, including payors, providers and patients. The shift to value-based care and capitated payment arrangements opens the door to have these conversations. The value is most certainly in the outcomes,” Colovin said, “As providers, we have an opportunity to demonstrate value to payors by shining light on the known social barriers that drive poor outcomes and offering innovative solutions, such as meal delivery, cooking classes, clinician-led remote patient workgroups, caregiver training and fitness programs through community partnerships.”

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