Florida-based hospice and palliative care provider Haven has tapped its chief medical officer, Shirley Codada, M.D, to lead the charge on expanding its community-based palliative care program. Haven has long provided inpatient and home-based palliative care. The new initiative will build the provider’s penetration in nursing homes, assisted living and other facilities.

Haven cares for patients in 18 counties concentrated in north central Florida. Codada joined the organization this past summer after having served as regional medical director for hospice programs in Florida and Georgia for one of the nation’s largest providers.

Hospice News spoke with Codada about Haven’s expansion plans and her insights on how the health care system can better scale — and pay for — palliative care. 

You have said that the pandemic has fundamentally changed how and where seriously ill patients want to receive the care and assistance they want and need. Can you add some color around what specifically you have seen change?

I realized that patients want to be in their home much more than they want to be in the hospital, much more than they want to die in hospice in a care center. They want to be at home.

When you look at what happened during the COVID pandemic, a lot of the patients started having fear around the fact that their family could not visit [if they entered a facility]. They started having a lot of anxiety. They started having insomnia. And their family members felt the need to take them out of the places where they were, such as skilled nursing facilities. They didn’t want to be in the hospital and linger there. So really, the pandemic showed them that they needed to be in their own home with their loved ones. 

You’ve been tapped to lead Haven’s expanded palliative care program. Can you tell me about that program and how it differs from what Haven has done in the past?

Haven has offered the palliative care program now for several years, but it was mostly inpatient palliative care. There was a community-based component where we went into the patient’s home and saw them, but we realized the need is greater in the skilled nursing facilities, long term care, and post-acute care facilities. That’s where we wanted to expand our services.

There were also some of those facility directors who realized that their patients needed services, and they understood better what we could deliver in terms of care coordination, symptom management, and the course of care for their patients. That’s why they were looking for partners, and we are ready to offer that partnership, considering that we have all the elements necessary to do so.

So you’ll be providing this care primarily in those facilities, or will you also be going into private residences?

With some we will be going into private residences. It’s a commitment that Haven has to the community. It’s not really something that brings in a lot of money per se, but it’s something that we can do for the community and our partners — especially with physicians who are looking for added services for their patients who are leaving the hospitals.

Those patients are scared, and they know that they need somebody to catch them, because they’re likely to fall. We’ll continue to provide that care in the home for those patients.

What are some of the steps you’re taking to build out that program and make it grow?

We have a new marketing vice president who went out and met with these owners, doing a “listening tour” of these facilities to see what their needs were. When they started talking a little bit more about their needs, she understood that what they were saying was that they really needed more, expanded palliative care services. 

We were able to see that we could help each other, then we started looking to come into those facilities to provide the services. There’s some doctors that are medical directors of those facilities. Because they’ve seen us do the work in the hospitals, we are now trusted partners. So they also wanted to have us help them out in terms of providing this type of services in their facilities.

What would you say are your top priorities right now in terms of advancing palliative care?

My top priority is really about the patients and their families. We in health care always tend to provide health care services, but not always as true health care partners. We need to become true partners of those patients, so they know that we are here to catch them when they fall. They’re scared. They don’t really know what’s out there. They have very serious illnesses, and the system is providing fragmented care.

Medicare encourages us to be able to coordinate that care from the beginning of their serious illness, and through that care continuum, all the way to the end. We still don’t always have the means to do so, but this is something that I think patients need. 

If you have a patient who is diagnosed with a serious illness, some have to continue sometimes to be parents, to be spouses, to be able to earn a living. They have to make appointments to come to a doctor’s office. Sometimes they’re so sick after care, such as a patient getting chemo, they need to be taken care of after all that. People don’t know resources are available to caregivers.

We can help them to navigate all that, provide them with symptom management, almost like one-stop shopping. We can work in collaboration with their primary care physicians. We at Haven are also board-certified not only in hospice, but also some of us in internal medicine, family practice. We know how to manage a lot of those patients with primary basic care, although that’s not what our focus is. We still can provide an alert to their other physicians as to what’s going on with them.

One challenge in the palliative care space is that of securing sufficient reimbursement. What kind of payment arrangements do you have for your palliative care program? Are you working within fee-for-service primarily or Medicare Advantage?

We are working primarily in fee-for-service. Although we are working with other hospices within our area and looking into a group that joins several small hospices in Florida. They are looking to better position themselves to really be able to to accept those value-based offerings that are available. 

We’re not merging, but we are really kind of putting our talents together to really come up with a program where if those companies were to come in we can partner with them in the future. We’re simply meeting now and trying to really discuss directly contracting and some of those value-based models. It’s in its infancy, but that’s something we’re looking to do.

What would you like to see change in the coming years in terms of payment for palliative care services?

The health care system provides a lot of fragmented care. If we engage those patients a bit more upstream, I think we are going to make a difference. And what are we going to do upstream? It’s goals of care, advance care planning, providing them with symptom management, and making sure that they’re feeling heard and understood.

I’ve had patients who came to my clinic for pain management, and they will not even touch pain medication. They came because they had somebody to talk to help lessen their anxiety, help them understand their disease process.

The health care system is not helping those patients understand their disease process. We’re not talking to their caregivers and educating those caregivers on what what needs to be done.

In the past I worked in a research project to empower those caregivers and really put together a program that those patients can benefit from and that will really will keep them from going other places, like the hospital.