Behavioral Health, Chronic Disease Among Top Health Care Macro-Trends Impacting Hospices

Though operators often feel siloed within the Medicare Hospice Benefit, they are not shielded from the shifting currents in the health care system at large.

This is the first of a series of articles that will explore these trends, beginning with the meteoric rise of behavioral health and chronic disease management — both as essential services and business opportunities.

Their growing prominence is leading more hospices to see innovative partnerships with upstream providers as well as building out their own programs.


“I think some of the trends include behavioral and mental health and the factors that affect our patients and families, even prior to qualification for hospice services,” Jet Health CEO Stacie Bratcher told Hospice News. “We’re seeing a lot of chronic illness, and because the physicians who are treating those patients often don’t really understand the value of hospice, we often see those referrals come in the last 14 days of life.”

As of 2021, patients with chronic illnesses or mental health conditions accounted for a staggering 90% of the United States’ $4.1 trillion annual health care expenditures, the U.S. Centers for Disease Control & Prevention (CDC) reported.

While the term “behavioral health” refers to a broad spectrum of services, including services for mental health, autism, addiction and eating disorders, among others, some aspects have dovetailed with hospice care since the foundation of the benefit.


Addressing the psychosocial and spiritual needs of patients and families — including bereavement care, social work and chaplain services — have long been integral to the hospice model.

Now, both behavioral health and hospice care are finding greater acceptance as well as burgeoning demand, leading providers to consider new ways of collaborating or integrating concepts from each into their business and care models.

Long-standing social stigma around mental health care is largely dissipating globally, according to a 2020 survey by the HealthPartners Institute.

As with many health care trends these days, the pandemic helped shape that trajectory. Globally, depression and anxiety disorders have proliferated during the outbreak, reaching 53.2 million and 76.2 million respectively in 2020 alone, according to a study published in The Lancet.

The uptick in demand brought a flood of investors to the behavioral health space. This included a sizable contingent of private equity firms as well as strategic buyers, according to Dexter Braff, president of the M&A firm The Braff Group, who recently spoke at the Behavioral Health Business INVEST conference in Chicago.

“The expectations of the investment community when COVID began to really put folks into the market. They really said, ‘We need to get into the space,’” Braff said at INVEST. “There are lots of developments that began to elevate behavioral health, but COVID jumpstarted that because more money was coming in, and the need for services was definitely going to go up.”

Deal volume for behavioral health increased 33% in 2021, Hospice News’ sister site Behavioral Health Business reported.

Case in point, Androscoggin Home Health Care + Hospice last January acquired the behavioral health care company Care & Comfort for an undisclosed sum. The deal followed a community health needs assessment that indicated that far more Maine residents needed mental health care than were receiving them, Androscoggin CEO Ken Albert told Hospice News.

“There’s lots of conversation about how the behavioral health and physical-medical models need to be more integrated, and we need to merge them if we’re going to manage chronic disease more effectively,” Albert said. “Behavioral health was the number-one gap in every single county in our state. As we’re looking at continuing health care needs, and looking at our skill set, it makes sense that we would be looking also at our need to diversify our revenue streams for sustainability.”

Concurrently, chronic illness management is another area in which hospices see both a need they can help address and an opportunity to expand their businesses.

About 10,000 people in the United States become Medicare eligible every day, a trend that began in 2011 and is expected to last through 2030, according to the Medicare Payment Advisory Commission. The National Council on Aging reports that close to 80% of those older adults have at least two chronic conditions.

Recognizing this, upstream providers are taking gradual steps toward designing interdisciplinary, person-centered services that include goals of care conversations and programs to address social determinants of health. But, for now, hospices continue to be the resident experts in those types of care models in today’s fragmented health care system.

This has led operators to develop more longitudinal programs oriented around the needs of chronically ill patients, including palliative care, disease-specific services, home-based primary care, PACE and a range of others.

As these hospices establish and expand their upstream modalities, it will be incumbent on them to show referral sources, patients and payers how partnering with a hospice can improve outcomes and reduce costs well before the end of life.

“We’re really focusing on an opportunity to educate our medical communities as a whole,” Bratcher said. “If we can become involved earlier in those patients’ lives, we can have much more of an impact.”

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