AccentCare, Seasons Hospice Pursue Seamless Care Continuum, Hospital-at-Home

Via their upcoming merger, AccentCare and Seasons Hospice & Palliative Care are integrating their business lines to create a home-based health system providing a spectrum of post-acute care services. Meanwhile, the companies are investigating ways to provide more advanced care in the home setting.  

AccentCare is a portfolio company of the private equity firm Advent International. The combined organization post-merger will become the fourth largest hospice provider in the nation, according to AccentCare CEO Steve Rodgers. Financial terms of the merger were undisclosed.

“What this merger does in terms of our clinical programs is really enable us to have a real continuum of care in the home in many more marketplaces. We’re looking at how we do more advanced services in the home, taking people home from the emergency room, rather than admitting them to the hospital,” said AccentCare Chief Medical Officer Anna Loengard, M.D.. “[The merger] gives us an amazing platform to really see how we take what we’ve started on both of our sides of this spectrum, bring them together and be able to make this much more synergistic.” 

One critical need that the companies are seeking to address is improved patient navigation through the health care system. As the health care system has grown larger with a lean towards institutional care, the chronically and seriously ill are often falling through the cracks or not receiving the full range of services that could benefit them. 

Some of this is a function of payment. For example, a seriously ill patient may not be able to receive interdisciplinary palliative care without support from a home health care provider due to the way Medicare reimburses for those services, according to Balu Natarajan, M.D., chief medical officer for Seasons.

Typically, Medicare will pay for palliative care physician services through the Part B fee-for-service system, but in the absence of a community-based palliative care benefit may not cover the full range of interdisciplinary care, including chaplains, social workers and nursing visits.

“So much of what health care is trying to figure out right now is patient navigation. Long ago, this was supposed to be the job of the primary care physician, and as we’ve gotten bigger as a health care system somehow the actual navigation of the patient hasn’t come to fruition, especially for those who are progressively more sick, more frail and more elderly,” Natarajan told Hospice News. “Everyone in the system is trying to connect the dots, and yet the system doesn’t connect the dots”

Among the innovations the companies are considering is implementation of a hospital-at-home model that could provide higher acuity care in the patient’s residence. These internal discussions began prior to the U.S. Centers for Medicare & Medicaid Services (CMS) recent announcement that it would pursue a waiver permitting reimbursement for hospital-at-home services.

These actions come at time when the COVID-19 pandemic is driving more care to the home setting rather than institutions, as hospitals and other facilities become overrun with infected patients and more patients stay home to avoid exposure to the virus. 

The absence of a clear payment model for high-acuity home care has been a hindrance to the greater development of those services, but the needle is starting to move, according to Loengard.

“Patients who are extremely frail do best in the home rather than in institutions. That’s got to be the vision — a seamless, higher-acuity system that can actually meet the needs of patients at home with in-person care and also with technology,” Loengard said. “During the pandemic health care really has busted some norms and stretched people beyond their comfort level, because there was no choice.”

As AccentCare and Seasons work to build a seamless care continuum, they are finding new opportunities to learn from one another and the distinctions in their current operations. Seasons, for instance, has an internal medical staff whereas AccentCare generally contracts with physicians. 

While the companies will not need to renegotiate any relationships with payers, joint ventures or referral partners as a result of this merger, they indicated an intention to work with payers to ensure that reimbursement is conducive to ensuring patient needs can be met in the home. 

“As payers get more sophisticated, they’re starting to be more forward thinking, I think we’re going to see more [payment model] pilots, and strangely enough, I think the pandemic has set the table for that,” Natarajan said. “I think when we catch our breath and look back on what we learned this year, we’re going to see all kinds of innovation and opportunities in home- and community-based care.”