Avow, Haven, St. Francis Reflections Lifestage Care and Treasure Coast Hospice have established the Synthase Collaborative in part to leverage their collective scale in value-based contract negotiations. The move is part of a growing trend among nonprofit providers.

The collaborative is not a merger. Each of the hospices involved in Synthase will maintain its autonomy. Members will work together on securing payer contracts, sharing best practices and cost reduction efforts.

Synthase is named after an enzyme that catalyzes bonds between molecules.

“Our brainstorm between the four organizations turned into figuring out how we could form a more formalized collaborative, which ultimately would help us not only with the Medicare Advantage carve-in, but even other services that we provide,” Jaysen Roa, president of both Avow Hospice and Synthase, told Hospice News.

The advent of regional nonprofit collaboratives is driven to a large extent by the hospice and palliative industry’s gradual migration towards value-based payment models. The most prominent of the current models is the hospice component of the value-based insurance design demonstration, commonly called the Medicare Advantage carve-in, which began Jan. 1, 2021.

Hospices that participate in the carve-in will have to negotiate payment rates with private Medicare Advantage plans, which often lean towards larger providers that can cover a larger geographic area.

The four Synthase members care for an average of 2,200 patients daily and more than 18,000 adults and children annually. Together, they serve 23 Florida counties, representing approximately 4.5 million residents, or 20%, of the state’s total population. As time progresses, the collaborative expects to bring in new members, according to Roa.

The Medicare Advantage carve-in has yet to arrive in Florida. The demo is not available nationwide but will expand in coming years, making it necessary for hospices to prepare if they plan to participate.

Florida providers are paying close attention in part due to the Medicare Advantage penetration rates in their home state. Florida is one of two states in which at least 50% of Medicare beneficiaries are enrolled in MA.

In June 2020, 2.27 million Florida residents enrolled in the program, a 24% increase year over year, according to the Kaiser Family Foundation. 

The collaborative is also considering ways to pursue additional contracts such as payer relationships to support palliative care programs or other non-hospice services.

“We are looking to go after different types of care contract models that we’ve seen through different insurance companies, essentially that are either capitated or per diem models and utilizing our existing code of programs,” Roa said. “Many of the models are fairly new, and they’re still trying to work out exactly what they look like. But with the collaboration coming together and having our size and our scale in the geography of Florida that we cover, we will certainly be able to show value.”

Synthase is the latest such collaborative to come together during the past several years. Collaborations such as these have been vital for many smaller hospices to remain competitive with larger players in the space and to maintain eligibility for value-based payment programs.

Last July, a group of hospices and home health providers in Colorado established a similar initiative called Care Synergy, including Denver Hospice, Pathways Hospice and Pikes Peak Hospice and Palliative Care, and The Colorado Visiting Nurse Association.

Also last year, seven hospice and senior care providers formed a multi-state collaborative branded as Advanced Illness Partners, a joint venture geared for participation in the Center for Medicare & Medicaid Innovation’s direct contracting payment models.

Five Wisconsin hospices formed the Wisconsin Hospice & Palliative Care Collaborative (WHPCC) in February 2021. Other examples include the California Hospice Network (CHN), formed in 2019, the Oregon Nonprofit Hospice Alliance and Ohio’s Hospice.

“As this new [value-based] payment methodology, so to speak, continues to progress, I think it’s going to be crucial for our long term survivability, as well as our overarching goal in any decision we make — which is making sure that patients and families receive exceptional care, regardless of who the payer may be,” Roa told Hospice News.