Two barriers interfere with palliative care growth — identifying patients in need and a fragmented reimbursement system, according to Laura Templeton, COO and executive vice president at Compassus.
As a nurse, Templeton has leveraged her clinical experiences to help navigate challenges that prevent patients from accessing care. She recently ascended to her current executive role at Compassus after roughly a decade with the company.
Tennessee-based Compassus provides home health, home infusion, hospice and palliative care across 200 locations in 30 states. The post-acute provider’s services extend across the post-acute care continuum, with a growing focus on palliative care. Among its recent moves into the space included a value-based collaboration with VNS Health to improve access, awareness and quality of palliative care.
Palliative Care News recently sat down with Templeton to discuss some of the driving forces that are posing both opportunities and challenges around sustainable palliative care service growth.
Highlights from the conversation are below, edited for length and clarity.
What has led your career journey into palliative care?
I’m a nurse by background. I worked in acute care prior to coming into the more integrated home-based care scene at Compassus in 2012. Nearly 11 years in the space with the nursing background gave me a desire to care for patients falling through the cracks of fragmentation that exists in our health care industry.
From a palliative care perspective, I got a taste of the hospital scene and overseeing a palliative care program in that setting. What I saw was missing the mark on the opportunity to serve more patients and provide more comfort outside the hospital setting and into the home. Being a nurse meant I saw the care bridges that needed to exist.
Sometimes we have a gap in identifying patient needs appropriately in our health systems, whether it’s palliating symptoms or identifying care support resources they need. There’s a huge opportunity to provide palliative care wherever the patient needs it in the continuum. Meeting the patient where they are at in that care continuum can really help identify their needs as illnesses progress.
What factors drove you and your organization towards the palliative care field?
Palliative care can serve as a bridge to many other health care segments, including home health and hospice, among other services. It can serve as a bridge for patients and families when making care decisions. One of the most beneficial aspects besides symptom and disease management is really talking about goals of care with palliative patients.
Your palliative care team can be instrumental in listening to the goals of a patient and helping to guide them around the care they desire. It’s building a care plan that is right for the patient and a care coordination plan that addresses that fragmentation.
A large benefit of palliative care is being able to both identify patient needs and opportunities to help address the full scope of family and caregiving needs as well.
What are the biggest hurdles to operating a palliative care program in your region?
Palliative care is a good care coordinator. A big hurdle in the space is the identification of patient needs and aligning services around that. Sometimes patients don’t know they need palliative care or the benefits they could have with these services. The education component is key to really inform the patient and their family of what palliative care really is and how we can serve them.
The second large hurdle in breaking down those misconceptions is reimbursement. That’s an important part to support palliative care service lines. You have to be a little innovative in that space, given the hurdles we have around payment models.
How has Compassus navigated through those palliative reimbursement and patient identification challenges?
One approach we have is understanding [clinical] capacity and the ability to serve the needs of our patients and communities.
We have different models to serve the community with palliative care services. We’ve set up advance care management teams and developed more interdisciplinary services where nurses, social workers and nurse practitioners are working together in really aiding the care of the patient. It takes being creative and innovative in the space and strong advocacy for potential palliative payment models that support their needs.
One model is more of a fee-for-service reimbursement system, while another model is based on a more per-member, per-month billing cycle that’s set up with payers through Compassus.
Where is the ‘sweet spot’ of palliative care service sustainability?
Each community has different needs, and it’s about working on care delivery and payment models that better serve those needs. It’s working with your partners in the community to identify and navigate patients at various levels of care with serious illness needs.
An integrated care delivery model is part of having a palliative care service line. That model is how you attract and retain talented practitioners in this area that are passionate about what they do and the communities they serve. We have seen the benefits that palliative care has to the patient and clinician because of the rich conversations they’re having in this work.
It’s being able to see what community-based palliative care can do for patients and then really work with payers to be able to serve them. It’s an extremely needed service that many people could benefit from in palliative care. Organizations have to be creative in how they fund that.
What do you see as the biggest rewards in providing palliative care?
The biggest reward is that this is a service for a patient and family dealing with chronic health issues and concerns.
From a clinician standpoint, it’s a needed service you’re bringing to patients. From a reward standpoint, it’s patients and families that benefit, especially when they start having goals of care conversations earlier. Being able to sit and talk about what patients and families wish to accomplish is rewarding for the clinician and the family experience.
From a provider standpoint, patients that would discharge from other settings get the right level of care at the right time. If we didn’t offer palliative care, then there’s a missing piece in what we’re offering. The reward for us is that patients can transition seamlessly between service lines.
What would be your biggest piece of advice for those interested in launching into palliative care?
I would say to figure out ways to do it before launching palliative care services. Work on different models that serve your community’s specific palliative needs. It can be beneficial to see what’s working and what isn’t in your community and what to offer patients and families.
To do it successfully, it’s knowing the needs within that community to then be able to build a scalable and sustainable model that provides palliative [services] that meet the needs of patients.