Collaborations between palliative and primary care providers may be on the rise, a trend that could give way to competitive edges around referral streams.

Many patients lack access to palliative care in part due to lagging reimbursement for these services. This is among the reasons driving more palliative care providers to join forces with primary care providers to bridge gaps in payment, according to Tiffany Hughes, COO and nurse practitioner at Texas-based PalliCare Inc.

Both primary and palliative care providers are working to break past payment barriers to improve access to quality in the face of rising demand for serious illness care, she said. Forming collaborations can be an avenue to supporting the full scope of interdisciplinary services involved, Hughes stated.

“I have definitely seen firsthand the increased interest in palliative care for these large physician groups that are based in primary care,” Hughes told Hospice News in an email. “On a macro level, I think the interest in palliative care comes from provider groups that are in some type of risk model. They have many problems to solve in their high risk populations, since these are usually the highest cost patients and are now monetarily incentivized to figure it out. They know the traditional office setting isn’t working, so they are looking for innovative models to help move the needle.”

For example, a recent collaboration formed when Partners In Care last year formed a strategic partnership with the primary and urgent care provider Summit Health aimed at increasing access to palliative care in central Oregon. The two organizations joined forces in 2014 when Partners In Care began offering palliative care services to patients at Summit Health’s oncology department.

Among the drivers of the partnership was when Summit Health became its own Accountable Care Organization (ACO) and wanted to add palliative care as part of its “medical home,” according to Partners In Care CEO Greg Hagfors.

Looking ahead, the new Making Care Primary (MC) demonstration from the U.S. Centers for Medicare & Medicaid Services (CMS) could create opportunities to pull palliative and primary care providers closer together.

Set to launch in July 2024 in eight states, the 10-year demonstration period is designed to allow CMS to expand and enhance care management and coordination of primary care across the continuum. The agency is aiming to equip participating primary care clinicians with tools to form partnerships with specialists and to leverage community-based connections to address patients’ health and social needs, including palliative care providers.

Another driving force behind primary and palliative care collaborations is the unique skill sets that palliative care providers can bring to the table, according to Heidi Warpinski, senior director of pediatrics and palliative care of Unity Hospice & Palliative Care, based in Wisconsin.

Many clinicians lack exposure to palliative care during their medical training, and these collaborative relationships can help expand awareness and access around the benefits of these services, she indicated.

“Robust education and integrated collaboration would be essential, as increased hand-offs between care settings would become more apparent for a patient across their continuum of care, versus being coordinated seamlessly through a community-based/home-based program,” Warpinski told Hospice News.

Addressing gaps in clinicians’ understanding of palliative care is a goal for Unity’s community- and home-based supportive care management program, which offers a specialized type of palliative care services.

Through the program, the hospice and palliative care provider has experienced a rise in referrals from primary care providers within its service area, Warpinski indicated.

Unity has worked to educate local and regional primary care providers and their staff about the value of supportive care management for their patients, she said.

“By promoting a deeper level of understanding for providers regarding definitions of eligibility for palliative care, clarifying the collaborative nature of wrap-around home-based services offered for symptom management, psychosocial and spiritual support, and committing resources to guide completion of advanced care plans, a level of trust and recognition of the value of these services to their patients is being realized,” she stated.