Health care providers across the continuum are recognizing the importance of partnerships, communication and coordination with providers in other settings. This is particularly true for hospice and palliative care providers, who must combat widespread misperceptions about the work they do and the services they provide. 

Sarah Kivett, director of community partnerships for North Carolina-based Hospice and Home Health of Iredell County recently spoke with Hospice News about the ways the palliative care space is evolving in terms of payment and community engagement, as well as their partnership with a local Accountable Care Organization (ACO).

What are some of the factors that are driving the rising interest in palliative care?

I think that the need for more involvement in the older population as we have more adult children who are caring for their parents. Just this last week I was asked to speak at one of our churches where they were doing a program about caring for adult parents. There were over 70 inquiries that they had and that community alone about being able to listen to that information. 

There is just the growing need of trying to help navigate how to care for the older population and their medical problems and psychosocial issues that come along with that. It can be very taxing on the whole family unit. In palliative care, we do not focus just on symptom management. We also focus on the psychosocial issues with our licensed clinical social workers, our chaplains, and our nurses. It’s working with the whole family and how they can best care for their loved one, whether that’s within the home setting, or whether that’s helping them to navigate the system for possible nursing home placement.

What do you see on the horizon in terms of the payment landscape for palliative care?

We actually participated in the Medicare Care Choice Model. We felt that that was very important because we have a unique patient area that we care for. The southern end of our county is a suburb of Charlotte [N.C.], but the northern end of our county is very rural. We wanted to participate in that study, because we felt very strongly that we needed to make sure that we had a voice and in what changes may need to be made within that structure of payment.

That study looked at how hospice-like services were provided to patients earlier while they are still seeking traditionally more aggressive treatments and whether that would decrease hospitalizations and hospital encounters. We did find that to be true for our area. 

We had patients that understood hospice better by having that introduction while they were still seeking more of your traditional aggressive treatments. For example, if a patient was still on immunotherapy,they could choose to continue that while receiving more services within their home. That allowed them to understand exactly what hospice services are. They transitioned to hospice a little bit sooner and were able to use that Medicare benefit earlier in their journey.

Do you think that the pandemic has affected the trajectory of palliative care in terms of growth?

In our situation, we can’t say that we’ve seen an increase in palliative care referrals. We have seen an increase for our hospice side. Patients with COVID decline very quickly, and they are generally going to hospice directly. I can’t speak to what’s happening nationally, but that is what we are seeing in our community.

How can we ensure greater access to palliative care going forward?

I think it’s communication and understanding within the community that we are in partnership with their current medical plan. Our palliative care services are consultative. We primarily do home-based palliative care. We do have a palliative care nurse practitioner in our local community hospital and a palliative care clinic in a very rural area, but overwhelmingly we are home-based palliative care.

We need the communication with not just the providers — but the community — to understand that we are not coming in to take the place of their established physicians but to work alongside them to maximize their quality of life. Referring back to the program that I just did last week in our community, people were a little bit surprised by that.

A lot of people think palliative care is the same as hospice. There has to be more education for the medical community as well. I think we have to establish some trust. One of the things that we are working very hard to do with some of our community leaders is reaching more into our underserved areas, and establishing more relationships. We are now reaching out to our local health department, because they have a lot of community programs, and forming relationships with programs that are already established in these communities.

We’ve actually been invited to do a presentation on our services at a family reunion, which was kind of interesting. It was a relaxed informational session where we were able to talk to a lot of people and then they also had conversations within their own families.

Turning to your ACO partnership, how did you become connected with that group and what are some of the ways that you collaborate?

Our medical director a few years ago actually reached out to the president of our local ACO and talked about a possible partnership in which we can work together to help patients have fewer hospital encounters. A lot of our physicians that are in that ACO work very closely together with different consulting groups. One of the things that we were able to do is to have our nurses and myself work directly with the ACO, having conversations about mutual patients and make sure that those patients and families knew that we were all on the same page.

We continue to have a monthly meeting with nurse navigators in the ACO. That communication has been very important. We also meet quarterly with c-suite leadership to look at claims data to see exactly what their usage of our services are, who in their patient populations may be dying without hospice services and how we can provide that more upstream. It’s been a very good relationship. We are in constant communication with each other.

Do you have a payment arrangement through the ACO?

No, we are still fee for service. We are working within a preferred provider relationship, making it as easy as possible for us to be able to partner with them to care for their patients. Information sharing is very important. We are able to use our [electronic medical records] to get patient information back and forth very easily.

That communication has been just priceless. We’re noticing subtle things in their home that the patient’s physician may not be able to see or is not reported in an exam room. We know the struggles that they are having, and we can communicate that to their primary care physician quickly.