Five Wisconsin hospice and palliative care providers have formalized a partnership to maximize their scale and negotiating power with payers in value-based payment models. The current focus of the new organization, called the Wisconsin Hospice & Palliative Care Collaborative (WHPCC), is reimbursement contracts for palliative care, using the term supportive care management.
WHPCC has incorporated as a 501c3 organization comprised of Agrace, Rainbow Hospice Care, Unity Hospice, Hospice Alliance and Sharon S. Richardson Community Hospice. Their combined geographic footprint covers 80% of the state. Each member hospice dedicates a portion of an executive’s time to manage the collective’s operations.
These providers began to collaborate with each other several years ago on an informal basis. They began sharing best practices, quality initiatives, diversity programs and staff education and volunteer management opportunities. The establishment of WHPCC solidifies those relationships.
“We first got ourselves organized back in 2006. We had a nondisclosure agreement among the five of us, and we did quality benchmarking and other collaborations,” said Lynne Sexten, president and CEO of Agrace in Madison, Wisc. “As different challenges confronted the hospice industry, we’ve gotten more formal. We decided that we needed to become a provider network to contracts directly with insurers.”
Among those challenges was the need to gear up to work within value-based models in addition to the Medicare Hospice Benefit, according to Sexton. Providers had to develop payer relations skills in short order as the industry evolved. WHPCC is designed to shore up preparedness for participation in those models, according to Karen Carrig, CEO of Rainbow Hospice.
A number of value-based initiatives have launched in 2021, including the value-based insurance design model demonstration, or Medicare Advantage hospice carve-in, the Primary Care First Serious Illness Population model and several direct contracting options. During the first year of these programs, none are available in the state of Wisconsin.
While the Medicare Advantage carve-in and other new value-based payment models are not yet available in these providers’ home state, those programs are likely to expand to more regions over time. In the interim, WHPCC will be working with Accountable Care Organizations (AACOs) and through independent contracts with private payers.
“There has been some proliferation of ACOs and certainly the private payers relative to a palliative care or supportive care management program,” Carrig told Hospice News. “We’re going to be ready to have those conversations. We’ve also contracted with an organization to collect, aggregate and report quality data. That was a significant contract that the collaborative undertook.”
Generally speaking, reimbursement for palliative care is sparse, typically only covering services from a physician or licensed independent practitioner, WHPCC’s contracts allow for the full range of interdisciplinary care associated with supportive care management.
Through the collective, the five hospices will partner with payers under a single contract. They receive payment per patient, per month for supportive care management. Payers are using data analytics to identify seriously and chronically patients in need of those services with a mind to improve outcomes and reduce costs by decreasing hospitalizations and emergency department visits, according to Sexton.
The partnership comes with additional benefits beyond negotiating power. The companies have joined forces on quality benchmarking and improvement, revenue cycle management, compliance, policies and procedures related to hospice eligibility and other joint initiatives. They have also bargained collectively with vendors for discounts on services and supplies.
“One of the things that really served us well as far as these collaborations was the responsiveness to the COVID pandemic,” Eric Tetzlaff, administrator of Sharon S. Richardson Community Hospice, said. “As far as being able to collaborate with five hospices together with all of the unknowns that emerged, being able to adapt and compare practices, as well as compare human resource policies, I think that we had much better outcomes.”
The collaborative extends a growing industrywide trend of small-to-midsize organizations joining forces to leverage their combined resources in value-based payer relationships.
Recently, seven hospices came together to form a coalition called Advanced Illness Partners to create a direct contracting entity. The partners in AIP include seven nonprofit organizations: Pure Healthcare, Geriatric Solutions, Hospice of the Valley (Ariz.), Hope Healthcare, Housecall Providers, Cornerstone Hospice, Nathan Adelson Hospice and Capital Caring Health.