Evolving demographic and economic forces have placed palliative care among the nation’s fastest growing health care sectors.
Interest in the palliative care market has spiked in recent years, partly due to the value proposition these services offer to patients, families, providers and payers alike, according to Fred Bentley, managing director at health care consulting firm ATI Advisory.
“Number one, it’s a big satisfier for [patients],” Bentley told Palliative Care News. “Family members who have [loved ones] receiving palliative care find it highly valuable. And that is important to [insurance] plans, because the extent to which they can market and differentiate themselves on offering this kind of benefit is good. Palliative care is an interesting space, and it’s a bit nebulous and amorphous too. Can we expect to grow? Yes. There is more value, more flexibility and more reimbursement opportunities coming. Palliative care as a discipline is still evolving.”
Demographics and health equity
Roughly 90 million individuals in the United States have some type of serious illness, a number anticipated to double during the next two decades alongside swelling aging populations, according to a report from the Center to Advance Palliative Care (CAPC).
Rising demand is drawing more interest in palliative care, driven by demographic tailwinds, which are anticipated to propel continued growth. Current projections are that the industry could nearly double in market value size by 2030 and reach value amounts that tip into the billions.
Despite the demand, many patients who could benefit from these services do not receive them — an approximated 6 million nationwide, the CAPC report indicated.
The vast number of underserved groups represents an untapped opportunity for growth and expanded reach, according to Rory Farrand, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization (NHPCO).
“[Palliative care] is an evolving space of interdisciplinary care for seriously ill folks,” Farrand said during Hospice News’ Palliative Care Conference. “If you’re not learning about it and positioning your organization to already get engaged in palliative care, then you’re behind the eight ball a little bit already.”
Diverse investments and payment sticking points
Hospices, health and hospital systems and primary care providers make up the bulk of the organizations that are expanding into palliative care. The space is drawing an increasingly diverse mix of health care providers.
[Palliative care] is an evolving space of interdisciplinary care for seriously ill folks. If you’re not learning about it and positioning your organization to already get engaged in palliative care, then you’re behind the eight ball a little bit already.
— Rory Farrand, vice president of palliative and advanced care, National Hospice and Palliative Care Organization
“Those ‘37 flavors’ of palliative care that out there could lead to some interesting new types of care needed,” Farrand said.
A range of medical, psychosocial and behavioral health services can fall within the scope of interdisciplinary palliative care, including advance care planning services, among others. Its diverse application across the care continuum makes palliative an attractive area for business opportunities, Farrand indicated. It also brings varied approaches to care model delivery and development, she said.
“What we don’t have in palliative care is a standardized set of services, care delivery approaches and reimbursement,” Farrand stated. “That’s where it gets messy.”
As the number of palliative care programs proliferate, the competition may have positive impacts on access and utilization among seriously ill populations in need of palliative care, according to Dr. Andrew Mayo, chief medical officer at St. Croix Hospice. But a crowded field could have negative effects on quality and the way future reimbursement paths take shape, he said at the Hospice News Palliative Care Conference.
“Having more players in the field, it worries me that it’s going to influence reimbursement in possibly a negative way,” Mayo told Palliative Care News. “Meaning that payers will be able to get palliative care services anywhere and only offer you X amount for your services. Organizations may have to take that cut, and that’s the part that worries me about having more players in the space.”
Cost reduction opportunities in palliative care are also pulling interest towards the space, Farrand indicated.
Patients who receive palliative care are less likely to have rehospitalizations or utilize expensive emergency health care services, which leads to reduced overall costs for payers while also reflecting improved outcomes, she added. That means other specialty groups may increasingly be attracted to the space to leverage the value of their services with payers, according to Farrand.
As far as what’s coming next, that’s where the proverbial payment rubber hits the road, Farrand said.
“What’s on the horizon is going to be more integration of palliative care in the value-based arena. And so we really need to be thoughtful around it,” Farrand said. “We need to start figuring out how we will get a piece of the pie and get some of those shared savings on the back end. It’s learning more about value-based care and about risk-based reimbursement. They’re just going to get bigger.”
