Hospices provide about 50% of the community-based palliative care in the United States, but these programs are often viewed as a loss leader. Hospice Buffalo has leveraged data and relationships with payers to create a growing palliative care program that feeds their bottom line while addressing patient needs.
Stakeholders in the hospice space have recognized the importance of community-based palliative care delivered in the home, with increasing efforts underway among health care providers, state governments, advocacy groups and payers to make it more accessible to patients and families.
“I’ve had the privilege of this interesting vantage point of watching the advancement and evolution of palliative care from within the hospice construct,” said Christopher Kerr, M.D., chief medical officer & CEO of the Center for Hospice and Palliative Care in Buffalo, New York, during a recent National Hospice and Palliative Care Organization (NHPCO) conference. “We initiated a home-based palliative care program that was payer-sponsored 13 years ago, and this has grown dramatically. It started as a causal effort, and is now obviously a component to any health care system that places a premium on value and cost points. What has happened since has really been transformational, and multiple levels of the health care ecosystem have rapidly evolved in their recognition and willingness to partner and align around serious illness models such as home-based palliative care.”
Hospice Buffalo’s Home Connections is a community-based palliative care program that includes services such as 24/7 on-call nurse support, pain and symptom management, disease education, social work visits, help with care coordination, developing goals of care and assistance with advance care planning. The program aims to improve the quality of life for patients and their families, a common thread of growing focus for many hospice providers moving to demonstrate their value to payers in anticipation of the approaching Medicare Advantage hospice carve-in.
“Essentially what we have is the inverted value equation for pain ever more and receiving ever less in terms of quality and satisfaction,” said Kerr. “The cost is to the patients, and those with the greatest unmet needs are the palliative care patients. These are the sickest 5% to 10% of the population which are driving over half of our health care costs. Despite widespread acknowledgement that palliative care isn’t only needed, but it works, most patients are receiving this kind of care either under the hospice benefit or in the hospital. Our challenge is to extend palliative care beyond episode and beyond setting. Our view, fundamentally, is that we are a community resource for the education and advocacy of high-quality palliative care, whether we’re the providers or not.”
Leveraging payer relationships and data, Hospice Buffalo grew the palliative care program that not only seeks quality improvement, but also boasts financial benefits in terms of driving down health care costs across the board. Hospice Buffalo examined claims data to match patients and create a cohort, which resulted in cost savings for patients receiving home-based palliative care, most notably in the last three months of life. The data indicated that the cost-savings for patients receiving this care was approximately $4,000 per member each month, making the case to begin care further upstream.
“The challenge is everything from billing to the understanding of health care, economics and policy,” Kerr said. “It’s kind of hard to get into the swim and the effort may require operational sophistication or capacity that may not exist. It takes innovation and a willingness to invest. We got buy-in from our community through strong advocacy [that] palliative care absolutely meets the definition of value by improving quality while reducing costs. The cost savings is dramatic for patients receiving home-based palliative care.”
Navigating the payer field and demonstrating the value of home-based palliative care comes with both risk and cost, but forming community collaborations and partnerships across care settings can prove invaluable for providers and patients alike. Engaging patients further upstream in the course of their illness improves their quality of life as well as the hospice’s bottom line. Patient populations who experienced longer lengths of stay correlate to higher margins, according to a Medicare Payment Advisory Commission (MEDPAC) report.
“Hospice programs with upstream palliative care offerings are in a much better position to partner within the illness continuum going forward,” Kerr said. “We began our program with a hypothesis for home-based care which assumed benefit for all, including the insurance company, the hospice and of course, the patient and family. The stakeholders are multiple and include anything from hospitals to health care systems, accountable care organizations, etc. Since its inception, roughly 30 or 40% of the patients discharged from Home Connection ended up being enrolled in hospice.”