Former CareMore, Aspire CEO Marzouk: Hospices Need to Adapt to Ensure Telehealth Meets Patient Needs

Care has been moving deeper into the home even prior to the coronavirus pandemic, but COVID-19 has accelerated that trend with the added boon of virtual services to supplement in-person services. As virtual care booms, providers are navigating uncertain financial waters as they seek to innovate and differentiate themselves from competitors.

Public anxiety about entering hospitals and facility-based care settings has led to a rise in demand for home-based care. During the pandemic, hospices have continued to provide a range of interdisciplinary services to patients through telemedicine or audio-only services.

COVID-19 has made it even more important for hospice providers to make care convenient, easy to access and available in the home, according to Shaden Marzouk, M.D., CEO of NewCo. Marzouk until July served as president of CareMore Health and Aspire Health, subsidiaries of the health insurance giant Anthem, Inc. (NYSE: ANTM). Both are among the largest companies nationwide in the palliative care space. NewCo, a Hudson’s Bay Company (HBC) is an investment and businesses holding company that operates in technology, retail operations and real estate fields.

“Virtual care is here to stay. We need to think about digital innovations in telemedicine and remote monitoring, and really helping patients adhere to treatment plans — that’s going to be even more critical,” said Marzouk in a recent episode of the Hospice News Palliative Care Executive webinar series. “It’s really about integrating these solutions in a way that addresses that whole continuum of care, even towards the end of life and always making sure that we service the complex and high needs vulnerable population.”

The webinar was recorded during Marzouk’s tenure at Aspire and CareMore.

Telehealth is anticipated to generate a hefty return on investment in the hospice space. Nearly half of respondents (47%) to the 2021 Hospice Industry Outlook Report indicated that telemedicine and telehealth would yield the highest return on investment among technologies used in the field. Telehealth outpaced other solutions such as predictive analytics (20%) and electronic health and medical record systems (29%). The COVID-19 outbreak was indicated as a main driver in nearly 17% of respondents’ technology investments this year.

Growing telehealth services can allow for the ability to expand home-based care robustly in scale, according to Marzouk. A combination of telemedicine, remote monitoring and digital tools could make health care easier for patients and providers alike, according to Marzouk.

“Home care and virtual care really go hand-in-hand. Think about virtual care as the tip of the spear, and then ask what we can do to hand off to physical care?” Marzouk told Hospice News. “What can we do as we expand the digital tools that our patients and providers have now that are considered to be that tip of the spear? Can that care be at home first, is it convenient for the patient to come into the clinic, or does a patient need more acute care? It’s really blending all of these modalities of care in a way that our providers have all of these tools at their fingertips.”

An uncertain reimbursement landscape could pose challenges for hospice providers when it comes to telehealth. Currently, no reimbursement system exists for hospices providing telehealth. The industry also lacks quality measures for telehealth services.

Public policy has further driven growth in virtual care. As the pandemic hit the nation, the U.S. Centers for Medicare & Medicaid Services (CMS) issued waivers relaxing conditions of participation (CoPs) for hospices and health care providers, including expanded use of telehealth for patient care. During periods of national disaster, the U.S. Department of Health and Human Services has the authority to waive regulatory requirements under section 1135 of the Social Security Act, including those issued by CMS.

The $2.2 trillion CARES Act contained provisions related to hospice telehealth, such as permitting recertification of patients via telemedicine visits instead of face-to-face encounters.

A bipartisan group of U.S. Senators in May reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, first introduced in 2016. If enacted, the bill would expand Medicare coverage of telehealth service and make permanent flexibilities for virtual services implemented temporarily during the COVID-19 pandemic. The bill would give the Secretary of Health and Human Services permanent authority to waive geographic restrictions on telehealth services and expand originating sites to include the home and other settings. The bill would also allow health centers and rural health clinics to provide telehealth services.

Available data indicate that patients and families are generally satisfied with virtual care. Satisfaction with telehealth reached 88% among patients and their caregivers, according to a 2020 study published in the Journal of Pain and Symptom Management. About 78% of providers found that telehealth services were equally effective as in-person visits. Researchers concluded that telehealth could “successfully support clinical decision making for hospice reauthorization” and the findings showed that telehealth could be “reliable and acceptable for certain types of hospice care even before COVID-19.”

Hospice providers will need to adapt their services to ensure that they can meet the needs and goals of patients and their families via telehealth. Affordability, accessibility and quality of care will be key considerations, according to Marzouk.

“Expectations in health care are changing rapidly, and people want a more personal, integrated and compassionate health care experience that really addresses the whole person to produce better outcomes: medical, psychological and social needs,” Marzouk told Hospice News. “We’re going to be tasked over the next few years to really make sure that we in health care are adapting our services and operations to meet those needs. I can’t emphasize these words enough about affordable, accessible and high quality care. Underneath that is the fact that telehealth care needs to be personal and integrated and compassionate.”