How Hospice and Palliative Care of the Wood River Valley Built a Collaborative Care Model Without Medicare Certification

After more than a decade working in hospice leadership, Alli Collins came across something she had never seen before — a financially viable, all-volunteer provider that is not Medicare-certified.

Today, she is the executive director of the program, Idaho-based Hospice and Palliative Care of the Wood River Valley, which serves an average of 55 patients daily in a largely rural community. The organization’s interdisciplinary care model, which includes some concurrent care, is funded 100% through philanthropy.

Hospice News spoke with Collins about how the nonprofit company maintains its revenue streams, benchmarks for quality and the changes she plans to make after taking the helm.


How would you introduce your organization to people who are not familiar with your model?

I am the new executive director for Hospice and Palliative Care of the Wood River Valley. I’ve spent well over a decade in the Medicare-certified side of the world. I’ve run companies, been a clinical director and helped start hospices and a palliative program.

The organization has only had two executive directors, and it was established in 1985. A registered nurse started the company back in 1985, and it was 100% volunteer-based. Even the nurses just volunteered their time.


She saw a need up here in the community. It’s a rural community, and there’s not a ton of support up here. She never instituted a Medicare provider number. She decided to keep it community-focused and work with donors.

Fast forward to a few years ago, they instituted paying nurses and paying a team to take care of the patients in the community. So that’s the largest part of our direct costs.

We have a volunteer board, seven members, and a beautiful group of people. One of them is a retired CEO of St. Luke’s which is our local hospital system. They have been brilliant in setting up an endowment back in 2016. So we’ve been able to continue the work.

Coming from the Medicare-certified world, when I was looking at the opportunity, it took me a minute to wrap my mind around the model. But it’s a beautiful model because of the lack of complication.

Our volunteers actually go through a really lengthy training program and are willing to do that. We have nurses, a social worker and chaplains that donate their time. Our medical director is a volunteer and has been here for 22 years.

We support about 55 patients daily and do a combination of palliative and hospice, which is also lovely. So I have a good number of patients who are still receiving treatment, multiple cancer patients who are still receiving radiation or immunotherapy.

Without being Medicare certified, how do you benchmark yourself for quality?

When I was interviewing for this position I had the same question, because there is no compliance program here. And I’m a huge fan of compliance. So I do intend to build a compliance program. I do think it’s important to be able to benchmark quality.

I don’t have to tie all these regulatory requirements, but I have to ensure that — if we’ve initiated an opioid regimen, for example, we have a bowel regimen — which is one of the quality measurements for Medicare-certified hospices. It’s a best practice.

We know that in the Medicare-certified world, you have to do that and you have to report it. We need to be doing it too. There are a lot of best practices that we need to pull into what we’re doing here. I want to create a more formalized process.

How consistent is your funding from year to year? Do you generally have a predictable amount of revenue coming in?

It’s been pretty predictable in terms of year over year. We have enough to make our operating costs, we have funds to invest. And we have investors who are working those numbers to be able to grow the fund.

There’s a lot of philanthropic work that goes into raising the money, including an annual letter to donors, investment funds and just so many different things throughout the year.

How has the hospice developed its referral relationships?

It’s the longevity of the program, and then how it’s evolved. We work with a number of different referral sources, but most of our patients are referred by the local hospital, St. Luke’s Health System.

There are [no other hospices] up here. There is no other program in our area, and it’s been that way for a really long time.

St. Luke’s refers everybody they have to us. It’s a really collaborative system with the St. Luke’s doctors. The ER doctors now know me and have my cell phone number. That didn’t happen in the last 15 years that I’ve been working in hospice.

We work really collaboratively because patients might still be going back to either a physician or primary care provider (PCP). And then the PCP will call here and say they want to update the care plan or change some orders, and we work together. It’s definitely a much more collaborative system.

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