How ‘Responsiveness’ Became a Watchword for Prospero’s Growing Palliative Care Business

Prospero Health has leveraged education and responsiveness to grow its palliative care business.

The Tennessee-based home-based care company provides interdisciplinary services to 30,000 seniors with complex health needs in 28 states. That’s up from 1,700 patients in three states as of January 2020.

Underpinning that growth is a track record of reducing hospitalizations and emergency department visits among Medicare Advantage beneficiaries, Dr. Kris Smith, Prospero’s chief clinical officer, said at the Home Care 100 Conference in Orlando. But achieving those outcomes required all stakeholders to have a shared understanding of what they meant by “palliative care.”


“We realized that we were sort of hiring all these folks whose narrow definition of palliative care was either from their hospice lens or from their inpatient palliative care lens, where you’re only asked to come and work with really challenging symptom management,” Smith said at the conference. “So we really had to rethink what palliative care meant.”

No standardized or statutory definition exists for palliative care, and different providers and payers have applied the term to a variety of care models. These have ranged from consults with advance care planning to longer-term interdisciplinary services or transitional programs for patients who are yet hospice-eligible.

Going into 2022, Prospero decided to focus on making responsiveness a defining element of its palliative care service, according to Smith. “Everything about our operations got turned around to be responsive,” he said at Home Care 100.


In pursuit of this, Prospero sought to double their performance on two key metrics — the rate of visits within 48 hours of hospital discharge and the annual number of urgent visits per 1,000 patients, according to Smith.

As these numbers went up, Smith indicated, so did the phone lines at Prospero’s call centers, where nurses armed with structured algorithms can de-escalate cases that otherwise may have resulted in an ED visit.

“You’re sick, suffering; you’re scared; you get a visit, and what happened was the patient started calling more often,” Smith said. “Our calls-per-1,000-members doubled over the course of the year because we were no longer just calling ourselves a ‘call-us-first company.’ We were doing the things that would make patients and families want to call us first. It’s not about the magnet on the refrigerator; it’s about when the patient and families call, do you go.”

Prospero’s palliative care patients are predominantly seriously ill seniors with high rates of emergency room visits and low primary care utilization, many of whom have multiple chronic conditions and social determinants issues.

Preventing hospitalizations, readmissions, and emergency department visits among patients like these have become a priority as the health care system works to reduce the national spend.

Achieving these reductions has become a cornerstone principle of risk-based payment models. And, increasingly, hospices and palliative care providers are leveraging their track records on those metrics as they build relationships with referral sources and payers.

“I think there’s an enormous interest in building palliative care programs. But if you want your palliative care program to stand on its own two feet as a result of medical expense reduction for these patients in the last 12 months of life, it’s not just the goals-of-care conversations,” Smith said at the conference. “It’s not just being ready to manage complex symptoms in the last month or two. It’s about convincing the patients and families that you’ll be there and building infrastructure so that you can be responsive.”

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