This article is sponsored by Enclara Pharmacia. In this Voices interview, Hospice News sits down with Natasha M.S. Jackson, PharmD, Director of Training and Education at Enclara, to learn about the disparities and inequality in hospice access and other challenges providers face. She explains how providers can help push for greater health equity and also discusses her role developing Enclara’s learning and development resources.
Hospice News: What career experiences do you most draw from in your role today?
Natasha Jackson: I have worked in many different areas of health care, including providing clinical support at an accountable care organization and clinical management at Enclara, serving hospice organizations. Prior to joining the Enclara team I served as a clinical administrator where I created training and education resources for patients and clinical care teams. I frequently draw on these past experiences in my current role at Enclara as Director of Training and Education.
It is important that our training and education content be able to support our hospice partners and their daily activities. Our goal is to provide the most up-to-date, relevant information for the nursing team and medical directors.
What does the Director of Training and Education do for hospice providers?
Jackson: I support our hospice partners through the development of clinical resources, as well as training and education resources for our digital tools. It is important for hospices to have these resources at their fingertips as both clinical best practices and Enclara tools evolve.
My department focuses solely on training and education support for our hospice partners. We recently released our brand new At Your Pace learning center, a self-paced learning environment that allows users to train and complete interactive education sessions on their own schedule. Within the learning center we have designed e-learning courses, resource documents, videos, webinars and other tools that will help our partners. We also provide live training sessions and Q&A forums. Offering a variety of options allows us to get the right mix of training in place so hospice staff can best serve their patients.
The hospice benefit is a wonderful care option for patients, yet disparities and inequality to hospice access remain. Why?
Jackson: Health care providers want to make sure that health care, and the hospice benefit specifically, are available to all patients everywhere. The hospice benefit provides patients and families with decreased costs, better quality of life and support for patients and their caregivers, but we continue to see a small percentage of minority patients using it.
The hospice community has a responsibility to reach those patients. If you look at the national demographics, we are not quite there. Black and Hispanic Americans make up a very small percentage of patients who are utilizing hospice services. This is due in large part to a lack of understanding around what hospice can offer to patients, so it is important we continue to share that message.
It is also important to understand that patient preferences for end-of-life care can vary based on an individual’s racial, cultural or spiritual background. The hospice community must continue tailoring services to meet patient goals. I think there is a significant opportunity to provide education and knowledge about the hospice benefit so we can see it utilized across a broader patient demographic.
As you know, some numbers are improving. In 2016, nearly 87% of Medicare decedents were Caucasian, according to the National Hospice & Palliative Care Organization (NHPCO). That number was down to 82% in 2018, and according to Kaiser Family Foundation, it’s down to 74.8% in 2020. What has accounted for those changes?
Jackson: We are seeing more practices and providers having conversations about disparities in hospice use and bringing more awareness to hospice and its benefits. Dispelling some of the misconceptions associated with costs as well as clearly discussing hospice options goes a long way in building trust, which in turn opens the door for many other groups of patients to take advantage of what hospice provides.
What are the top steps hospice agencies can take to increase access to care?
Jackson: It all starts with initiating conversations about hospice care in the patient populations we want to reach. Through community outreach, hospice providers can have conversations about the best options for end-of-life care based on the values of the patients and families. To increase access, we must not only make sure people know about hospice but also incorporate their cultural and spiritual beliefs into our messaging and practice.
Having staff who represent the community the hospice wishes to serve can also help with outreach. Certain communities have less trust in the health care system as a whole due to past experiences, so representation within the staff can help jump-start conversations about how hospice can benefit a patient. Additionally, staff who represent the community which the hospice serves can help providers understand some of the nuances and desires within a specific culture or community.
Cultural competency training for staff is another big piece of the puzzle, and we are seeing a lot more of it today. Building relationships with trusted community members can help bridge the gap between underserved communities and access to care.
What is Enclara doing to increase access to care?
Jackson: Enclara firmly believes in supporting equitable access to care for all patients. In 2020, we worked with several of our hospice partners to create our Equity in Palliative Care and Hospice white paper (download link below). The white paper presents real-life experiences of hospice staff in addition to providing a framework for equitable access to hospice services. In 2022, we plan to expand on that framework with additional resources and tools.
What else is coming for Enclara in 2022?
Jackson: There is a lot we have planned for 2022, including additional training and education resources around health equity and cultural competency in hospice. Our goal with these tools is to assist hospice providers in building stronger relationships with patients and their caregivers.
Another big initiative for Enclara is our new E3 Pro application, which is our medication and patient management platform. New features make it easier for nurses to manage medications, allowing for more time with their patients. We have gathered a lot of feedback from our nurses and hospices throughout the E3 Pro design process to meet the ever-changing needs of the provider.
Entering this year, no one knew what to expect in the hospice industry. What was the biggest surprise, and what impact do you think that surprise will have on the industry in 2022?
Jackson: I think the biggest surprise for us as health care providers has been the staffing shortage across the country, which requires a constant need for adjustment and adaptation among hospice teams. In 2022 hospices will be focused on retaining staff while attracting and engaging new employees.
Enclara is assisting in the area of new staff training with our At Your Pace Learning Center which allows staff to complete their training goals on their own schedule. It also allows us to provide insights into training and education metrics to our hospice partners to make sure we are supporting their professional development goals. We introduced the learning center this quarter and it has been very helpful for onboarding new staff. Enclara is able to provide virtual support for new team members in learning the information they need to get started in their new roles
Editor’s note: This interview has been edited for length and clarity.
Enclara Pharmacia serves nearly 100,000 patients daily through partnerships with over 400 hospice providers across the country. To learn more about how Enclara can help your hospice, download our “Equity in Palliative Care and Hospice” white paper.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].