Turn-Key’s Terri Maxwell: A Population Health Approach Can Bolster Community-Based Palliative Care

Efforts have been growing among health care providers, payers, advocacy groups and state policymakers to make community-based palliative care more accessible to patients and families. Hospice organizations are extremely well-equipped to provide this care, according to Terri Maxwell, general manager, chief clinical officer and co-founder of Turn-Key Health. 

Turn-Key Health is a national community-based palliative care company which was acquired last year by post-acute care company CareCentrix, headquartered in Hartford, Conn. Based in Philadelphia, Turn-Key Health retained its name after the acquisition, which was rooted in a partnership between the two companies beginning in 2019, when each began to integrate their respective care management and predictive analytic platforms aimed at helping to identify seriously ill patients who were in need of community-based palliative care.

Maxwell is responsible for formulating the overall strategy, clinical care development, delivery, competence and quality of Turn-Key Health’s innovative home-based palliative care program, Palliative Illness Management™ (PIM). She worked as an advanced practice nurse in oncology for more than 20 years prior to focusing on improving serious illness and advanced illness care.


Maxwell recently sat down with Hospice News to discuss a growing trend of hospices providing community-based palliative care and the value proposition that these services offer to patients, payers and providers.

How is home care being reimagined as a primary care setting for seriously ill and dying patients?

Going into the home really deepens the trust and the relationships with patients and providers that get built over time. This focuses on where people are going to need and want care. Coming into their neighborhoods, into their homes and getting to know them there is a really critical part of palliative care and part of the secrets to its success. Hospices become this trusted provider for people as they journey through their illness, so that when it might be time to talk about hospice, they’ve got that relationship set for a future time. Hospice becomes sort of a normal part of the conversation with patients and caregivers, and providers become very skilled in identifying when to have those conversations and how to have those conversations more over time.


What is unique about a goal-concordant care model compared to the rest of the health care system?

With goal-concordant care, it allows us to restore power back to the patient and their caregivers. Asking what’s important to them reduces the focus of a patient getting narrowed down to their illness. People with truly serious illness have to figure out how they’re going to balance the care that they want and need with everything else in their lives, how it impacts their caregivers. Providers who know what the benefits versus burdens are to that patient, what is most important to them and the degree to which the overall plan of care fits with their goals, that is going to not just focus on the patient, but the caregiver and family unit as a whole. It’s a mix and pairing of clinical and a non-medical approach. It’s a care management approach, whether providing direct care or not, you’re coordinating care with ongoing assessments.

What might a growing trend toward community-based palliative care mean for hospice providers?

The move towards providing community-based palliative services really helps to establish a continuum of care that better aligns with what people want and need. That’s not as dichotomous unfortunately, due to hospice regulations and payment. Care can sometimes not necessarily be about what a hospice or patient wants to do, but rather how they’re financed. We can continue to be actively treated, if that’s what’s most appropriate or concordant with the patient’s goals. It’s a natural evolution for hospices to move upstream and be the providers who are really well positioned for home palliative care. Turn-Key overall finds that the teams we contract with, the hospice organizations are extremely well-equipped to provide this care. They do need additional support around providing care at home, but they do great and really well at caring for people with seriously ill care needs and demonstrating positive outcomes.

How can providers hone in on providing home-based palliative care in their communities? How could this expand their reach of hospice care as well?

If hospices are thinking of how they’re going to be able to do home-based palliative care, they can think of it in more of a population health perspective to find new payers and care and community partners. It’s going to be really hard to sustain if you envisioned this as a way to primarily boost a hospice’s enrollments. It shouldn’t be considered a bridge-type program that if you provide palliative care, then these people are going to decline over the next handful of months and we’ll be able to then enroll them into our hospice. Not everyone’s going to want to enroll in hospice, although we have been successful in achieving good hospice conversion rates, as well as people enrolling and staying on hospice longer. It’s really important that providers think about the palliative care program in the way that people who need these services may help them identify how they could provide this care in a scalable way, and how successfully they will be comes with an ability to demonstrate good clinical and quality patient outcomes, as well as proven cost-reductions back to payer sources.

What is the value of investing in home-based palliative care for hospices?

With more care arranged in the home, hospices have the ability to change patient outcomes and be able to demonstrate their value to payers by showing that it reduces costs, as well as improves the patient and family member experiences, and quality outcomes. Providing care in the home allows us to have more intimate conversations and helps patients make choices as well as, and that can ultimately decrease the total cost of care. Often if patients have time to think about what’s most important to them, they want to articulate it and document it, and that changes outcomes. The ability to change those outcomes is where providers will be able to go back to the health plans or provider groups and demonstrate their value and the value of these services.

What do you see happening in regards to programs addressing social determinants of health? How can hospices address social determinants in their programs?

Social determinants of health screening and assessments really get a complete picture of the patient. Hospices have been addressing social determinants of health and not talking about it forever, because the majority of people in hospice are in their home. The minute you start walking into someone’s home, you can see some of the issues that they might be coping with. It’s really important that we place a greater emphasis on life history and utilize a patient-centered approach to care that can really account for the person’s social environment and really focuses on health engagement with the patient and outcomes specific to social determinants of health. If we’re only focusing on their medical care or their illness, then we’re missing out on a vast majority of patients who want care in their home.

Companies featured in this article: