Palliative Care Expanding in the Hospice Space

Hospices are increasingly diversifying services to include palliative care, which many see as essential for the growth of their businesses and for success within value-based programs. Providers that are currently or planning to develop a new palliative care business line need to focus on growing and training their workforce, building relationships with payers and other providers, as well as get the word out about their programming.

Community-based palliative programming has expanded in the hospice space with cost-saving opportunities in evolving insurance payment models and improved patient access to care as leading drivers. About half of community-based palliative care providers in the United States are hospices, according to the Center to Advance Palliative Care (CAPC).

Florida TaxWatch, a nonprofit economic research group, reported last year that home-based palliative care could reduce overall societal health care costs by $103 billion nationwide over the next two decades. Providers investing in palliative care programming stand to benefit from the ability to demonstrate reduced health care costs, a goal under the forthcoming value-based insurance design (VBID) payment model demonstration projects set to take effect in January 2021, commonly called the Medicare Advantage hospice carve-in.


“One of the reasons that a lot of people are looking at palliative care right now is that palliative care can reduce the cost of health care,” said Maureen Kelleher, clinical consulting manager BlackTree Healthcare Consulting, in a recent webinar. “I think the more the government sees that palliative care helps reduce the costs, then the more insurance companies are going to start paying for it.”

Kelleher is also a registered nurse and health care administrator, has held senior management positions at hospice organizations nationwide and specialized in regulatory and compliance staff training.

Staffing training and education in serious illness care will be a crucial element of establishing and expanding palliative care programs. Ongoing workforce shortages resulting from staff burnout and high turnover have been a challenge for providers to contend with, as well as a lack of a specialized workforce trained in hospice and palliative care services.


“You want to make sure you’re going to have a strong palliative care program that’s going to build and grow on your outcomes,” said Kelleher. “You are going to need to be able to hire the right people to have a high-quality palliative care program because it is a subspecialty. There is a special passion and special education that you need to know how to just treat symptoms versus a disease. Communication skills are going to be a priority.”

A staff trained in communicating the appropriateness of palliative care would help to bridge gaps between care settings, according to Kelleher. Improved care collaboration is an additional goal under the hospice carve-in, with providers increasingly seeking strategies to improve patient access to hospice and palliative care and reach them sooner in their illness trajectories.

“You can’t do palliative care in a silo,” Kelleher commented. “You have to know who your competitors are and what partnership opportunities exist. Connect with oncology hospitals, nursing homes, physician practices, and primary care practices because palliative care is that connection to all of those services. The more partners you have, the more successful you will be in your palliative care program.”

Building up partnerships with providers broadens the scope of potential insurance payer relationships for hospice providers offering palliative care services in the value-based care arena. Developing strong alliances with partnering providers can lead to mutual cost-saving potential and improved access to serious illness and end-of-life care.

“It’s critical to be involved at the beginning of the diagnosis and not at the end of the disease process,” said Kelleher. “That’s where your alliances and your partnerships will help get you in sooner. You want to make sure that there’s early access to hospice support.”

Provider and payer partnerships will be key to supporting palliative care programming, with insurance payer input and patient choice key drivers of hospice referral sources under VBID payment model designs.

Educating partners about the value of palliative care comes with familiar hurdles for hospice providers expanding their serious illness programming. With persisting misconceptions about serious illness and end-of-life care among the public at large as well as many clinicians, spreading awareness through marketing will be vital for palliative care programming growth and long-term sustainability.

“Goals for marketing should be to build awareness about your program,” Kelleher advised. “You want to remind providers why palliative care is necessary and why it’s so important that they support a palliative care program. Focus on what differentiates you. What makes you special? Is it the people you’ve hired? Is it the services you’re providing? Is it that you’re the only one in the community who can do these things? Always, in marketing, under-promise so you can over-deliver. That is what helps your program grow.”

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