Though nonprofit hospices now represent a smaller slice of the industry than in years past, they continue to care for more than half of patients in the United States who elect the benefit.
The number of hospices operating nationwide rose to 5,358 in 2021, according to the Medicare Payment Advisory Commission (MedPAC). This is a 6% increase from the prior year, driven by a rising number of for-profits entering the market. Today, about 25% of hospice providers are nonprofit.
That is a far cry from the early days of the benefit when nearly all operators in the space had nonprofit tax status. Nevertheless, nonprofits continue to see a higher proportion of eligible patients, MedPAC reported.
This is the second in a two-part series on providers to watch this year in the hospice space. The first, published earlier this month, covered the for-profit sector.
Included in this list are organizations that are not only growing, but experimenting with new reimbursement and care models and diversifying their services to extend their presence more broadly through the health care continuum.
Ohio’s Hospice has been an innovator since its founding in 2013 and continues to have its eye on the future.
Nationwide, a growing number of nonprofit hospices are banding together in regional collaboratives to better compete with larger, often for-profit providers. Ohio’s Hospice was among the first to take this approach.
The organization launched with three hospice members and has since grown to include 11 affiliates, with Hospice of Morrow County as its newest addition in July 2021.
The network leverages its member organizations’ collective size in negotiations with vendors, payers and referral sources, collaborates on back-office functions and shares some expenses and infrastructure.
“Simply put, we are stronger together, based on shared mission, values, and culture, than we are apart. Frankly, the private equity- and venture capital-backed for-profit hospices have used our model, heretofore, unwilling to work together to our detriment and their advantage. They have created scale and taken market share at our expense,” Ohio’s Hospice CEO Kent Anderson told Hospice News in an email. “We envision a large network of not-for-profit, community-based hospice providers working collaboratively to create standards for what a community should expect from an end-of-life care provider.”
The collective and its affiliates have been on the frontline of value-based innovation that, in time, promises (or threatens depending on your perspective) to transform the hospice space. This includes the hospice component value-based insurance design model (VBID) demonstration.
Last year, Ohio’s Hospice — and its palliative care arm Pure Healthcare — entered into a VBID network contract with the CVS Health Corp. (NYSE: CVS) subsidiary Aetna. Admission to the network means that Aetna will also cover a range of benefits for Ohio’s Hospice and Pure Healthcare patients.
Those services include transitional concurrent care, monthly in-home support services, transportation and meals, fall prevention equipment, case management and a personal emergency response system device, among others.
Among the collaborative’s goals in the coming years is to help nonprofits nationwide proliferate their collaborative model, which has already spread among organizations in California, Wisconsin, Florida, Georgia, South Carolina and a range of other markets.
“We are committed to assisting and sharing our lessons learned and resources with other not-for-profit, community-based health care providers, irrespective of any partnership or contractual arrangement,” Anderson said. “We have shared our affiliation model with dozens of other hospice providers around the country in the hopes that they can find like-minded providers to create collaborations that advance their mission and ensure mission relevancy and sustainability.”
We are committed to assisting and sharing our lessons learned and resources with other not-for-profit, community-based health care providers.– Ohio’s Hospice CEO Kent Anderson
The organization has also established a partnership with the nonprofit senior living company United Church Homes (UCH) to expand hospice and palliative care options for its residents. Branded at Ohio’s Hospice at United Church Homes, it provides care in more than three communities across the UCH footprint.
Additionally, Ohio’s Hospice in 2021 began partnering with Kettering Health hospital system on a hospice and palliative care physician fellowship to help build up the clinical workforce in the field.
Member organization Ohio’s Hospice Lifecare also has partnered with the College of Wooster in its home state to grow its workforce through an emergency medical technician (EMT) internship program.
The company’s independent, affiliated palliative care provider Pure Healthcare is also on a growth trajectory. Recently, Pure Healthcare began collaborating with the nonprofit managed care organization CareSource to implement a new care management model designed to support chronically ill patients.
The initial rollout covers a 12-county region in southwest Ohio, but the organizations plan to expand statewide and beyond, according to Anthony Evans, president of Pure Healthcare.
“Pure Healthcare is our population health strategy through which we apply our core competencies of caring for chronically ill patients in new, value-based environments. We’ve proven that this combination of skill and experience can significantly reduce the overall cost of care for complex/high-needs populations,” Evans told Hospice News in an email. “These capabilities offer significant value to payers in the management of frail, rising-risk cohorts within their membership. Our goal at Pure Healthcare is to offer this value to payers and partner with them in value/risk-based opportunities to create a more sustainable future for our mission.”
Chapters Health System
The nonprofit Chapters Health System provides hospice care, palliative medicine, as well as durable medical equipment and pharmacy services, impacting approximately 105,000 lives annually in the southeast and mid-Atlantic regions of the United States.
Since 2020, the organization has more than doubled its hospice footprint, finalizing affiliations with Cornerstone Hospice & Palliative Care, Hope Healthcare and most recently, Capital Caring Health.
The Capital Caring Health affiliation extended the system’s footprint to Maryland, Virginia and the Washington, D.C. metro area. Cornerstone Hospice, Hope Health Care and Capital Caring Health joined Chapters Health’s already significant network of affiliates, which includes Good Shepherd Hospice, Hospice of Okeechobee, HPH Hospice, LifePath Hospice and Chapters Health Hospice, all operating in Florida.
To achieve this growth, the organization focused on ensuring a positive work environment for its employees to ensure it can meet swelling demand.
“Chapters unrelenting commitment to best-in-class employee experience is the currency fueling our ambitious growth curve,” President and CEO Andrew Molosky told Hospice News in an email. “Only at that level of scale and sophistication can the desire to see innovation realized be achieved.”
In addition to the new affiliations, Chapters Health introduced CareNu in April of 2021 as part of the original cohort of the Global and Professional Direct Contract Entity (GPDCE) program through the Centers for Medicare and Medicaid Innovation (CMMI). It serves as a population health, managed services organization, working with its ASSURITY DCE business line, which transitioned to the Accountable Care Organization Realizing Equity, Access, and Community Health model (ACO REACH) this year.
Capital Caring Health operates a robust home-based primary care program that is also expanding. That provider is also a founding member of Advanced Illness Partners (AIP), a direct contracting entity established by seven nonprofit hospices. AIP has transitioned from direct contracting to the ACO REACH model at the same time as Assurity DCE.
“We will continue to organically invest in the innovative care models we’ve become known for pioneering while fully welcoming those organizations who wish to partner for a successful strategic future positioning,” Molosky said.
We will continue to organically invest in the innovative care models we’ve become known for pioneering while fully welcoming those organizations who wish to partner for a successful strategic future positioning.– Chapters Health System CEO Andrew Molosky
In Hope Health Care, Chapters Health found an affiliate that can help build upon its commitment to the Program of All-Inclusive Care for the Elderly (PACE). The Medicare and Medicaid program is a signature offering for Hope Health Care known within the organization as Hope PACE. It helps elderly populations with services such as primary care, dentistry, emergency services, hospital care and meals without going to a nursing home or other facility.
“We’ve set our course to reinvent how chronic illness is managed in our communities and it will come through a balanced approach to managing core operations, organizational affiliations and disruptive innovation program launches,” Molosky said. “When taken in totality it will continue to be one of the most diversified portfolios of service offerings in the risk-based environment. There will be a concerted focus on actively managing federal, state and privatized revenue streams each with a value-based core.”
Also in Florida is the nonprofit post-acute care provider Empath Health. Established in 2014, the organization is now a parent company to 17 affiliates and two philanthropic foundations, with more than 23,000 people enrolled in its programs.
Its hospice brands include Suncoast Hospice, Suncoast Hospice of Hillsborough, Hospice of Marion County and Tidewell Hospice, which collectively operate throughout the state.
Empath provides hospice, home health care, primary care, palliative care, PACE, AIDS and sexual wellness care, and adult day services to a combined total of more than 23,000 individuals. In 2020, it merged with fellow nonprofit Stratum Health, thus expanding its footprint and scope of services.
CEO Jonathan Fleece took the helm at Empath in January following the retirement of his predecessor Rafael Scuillo. Among his priorities in 2023 and beyond is the organization’s new “One Hospice” initiative, as well as efforts to further expand its care continuum.
“In order for us to achieve both the quality and service outcomes that we seek, as well as to achieve our financial strength, as a strategic imperative we have to move forward in a ‘One Hospice’ direction,” Fleece told Hospice News in January. “That is basically standardizing our models of care, our support services, and our infrastructure (such as EMR systems). This is also very high on the 2023 agenda.”
The organization’s affiliate Tidewell Hospice also recently enhanced its clinical training program with a simulation lab at its Bradenton, Florida location. The lab is designed to give new hospice clinicians hands-on experience and hone their skills before they go out to engage directly with patients and families.
In addition to its hospice initiatives, the company is partnering with 10 other post-acute care providers to form the Accountable Care Organization (ACO), Responsive Care Partners, including several hospice and palliative care operators.
Empath has also been stepping up its investments in care models like PACE and adult day services. It opened a new adult day center, including a suite of veterans-specific services, in November of last year.
The company’s affiliate Suncoast acquired its PACE program in 2012, prior to the formation of Empath in 2014. Under Empath’s wings, the program has continued to expand.
“Health care historically has just been so fragmented, so siloed and uncoordinated. It increases costs. It reduces outcomes. It makes the patient experience less than ideal,” Fleece said. “It sort of circles all the way back to what Empath and full-life care really is, to bring health care closer together and do better with care coordination, care navigation, and achieve better outcomes for less cost.”
Companies featured in this article:
Advanced Illness Partners, Aetna, Capital Caring Health, CareSource, Chapters Health System, CVS Health Corporation, Empath Health, Ohio's Hospice, Ohio's Hospice LifeCare, Pure Healthcare, Responsive Care Partners, Suncoast Hospice, Tidewell Hospice, United Church Homes