Caregivers can be a key to reducing hospice revocations and the associated emergency department costs, according to Benjamin Swig, director of Acadian Health.
The trouble is that many hospices lack the staff they need to build relationships with family caregivers further upstream in a patient’s illness trajectory, leaving them with fewer insights around their health care options, Swig stated. He is also director of health care innovation and strategy at Acadian Companies, parent organization of Acadian Health.
A lack of awareness among families as to the nature and full scope of hospice and palliative care can cause many to turn to costly emergency services during times of health crises, he said.
Acadian Health offers acute care for recently hospitalized non-emergency patients, as well as at-home hospital care for critically ill patients that require 24/7 monitoring as well as advanced diagnostic services. The company’s clinicians integrate virtual visits with primary, hospice and palliative care services to assess patients’ needs in the home to reduce emergency and urgent care utilization and associated costs.
The Louisiana-based mobile community-based services company recently grew its service reach across Austin, Beaumont, Dallas, Fort Worth, Houston and San Antonio, Texas. These areas have rising volumes of aging populations with high levels of in-home acute care needs, a main reason the company chose to set its strategic sights there, according to Swig.
Collaborations with urgent care providers can help hospices to better engage with patients and family caregivers not only to increase access, but also reduce expensive health costs across the continuum, Swig indicated. The end result is a wider window of understanding on the hospice provider side as to the medical and social determinant factors that can create barriers to their services, he stated.
Hospice News recently sat down with Swig to discuss how hospices can bridge communication and connection gaps among caregivers through collaborations with in-home acute and urgent care providers.
Acadian HealthWhat types of health care services are you rolling out across with your recent expansion across seven markets in Texas?
Acadian Health focuses on trauma-informed, patient-centered care through the lens of quality. We assess symptoms that patients are experiencing in their home and help address those trauma needs as they happen.
At first, our existing customers were largely on the ambulance side. We then began to see value in identifying other types of health partners – especially hospices. There was a heavy need for additional support around end-of-life care in the home. We learned from having conversations with patients and their families that symptoms managed within the home really helped reduce hospitalizations and also hospice revocations.
We really focus on emergency diversion and leveraging diagnostics in the home to help identify and diagnose a slew of acute, chronic and underlying conditions. These include congestive heart failure, adult and pediatric asthma exacerbation, vomiting, nausea, dehydration, [chronic obstructive pulmonary disease (COPD)], pain management and several others. It’s identifying what is a preventable versus non-preventable emergency situation and getting them the right care and treatments at the right time through diagnostics in the home.
We view our role and approach as very much an interprofessional clinician. Giving these patients and their families diagnostic information can help them connect with providers that support them. We collaborate with different care teams and help solve those acute patient issues together in an appropriate and safe fashion.
Can you expand upon the driving forces behind Acadian Health’s recent growth?
These areas of Texas are where we already had existing ambulance resources, and expanding was our way of having a “backup to our backup” of health services.
In our space, we know someone isn’t using our services every day, and so we are currently contracting on a fee-for-service model that will give more access to in-home acute care services and resources. That means having multiple customers to support hiring those health care resources, and that takes having the payment infrastructure to build it.
Ambulatory services are in such a dire need of staffing support, and we come in to help cover some of these less urgent needs with our care partners. This can make hospice more accessible if it is needed and also give providers a reliable referral source. It also helps divert a patient away from the hospital if they don’t need to be there. All of this support takes a sustainable business model that makes sense. We want to be part of that solution and support.
Can you walk me through some of the challenges that you’ve seen as far as access to end-of-life support among aging populations?
Addressing inequities is another force driving us forward. It’s just becoming more aware of some of the issues blocking trauma-informed, patient-centered care among underserved aging populations and then putting a name to them.
We work with our health partners to hone their approaches and be more culturally aware. We can’t be culturally competent, but we can be culturally informed on equity issues. We teach our providers to just take a listener approach and be more informed based on what they can learn from each individual instead of putting a stereotype on them. It’s being sort of agnostic about who you treat and how.
Our staff engage in those active dialogues with individuals and learn specifically what’s impacting their health, their living situations and what pieces of care they need at different stages of illness. That’s a skill set we instill – to always be aware and learn from the various impacts of the individual populations we’re serving.
Those very human conversations are fundamental to building relationships with caregivers, patients and providers – especially as they reach the end of life and have more urgent or pressing care needs. They know they have someone to empathize and reflect upon those needs with them to help give them choices and options around care. We train our folks to facilitate those conversations and how they can look different across cultures.
It’s not just about a need for additional support for the patient, but also having those conversations with their caregivers so that they understand symptom management versus trauma needs. That is a key piece to helping reduce revocations on a whole, not only in hospice.
How do you see urgent care and hospice service lines intersecting? What’s important for hospices to understand about these intersections?
We dug into the data of where patients were coming from and going to across different health settings, and we learned that the top reasons for heading to the emergency department were preventable with more access to home-based care such as hospice or palliative services.
So we’ve shaped our programs to focus on a number of specialty care areas and chronic diseases among various populations. A big area we focus on is working with provider groups with patients that fall into the “at-risk” areas of higher emergency care use – mainly those with serious and terminal illnesses. This can be pediatric and adult populations. Another big area is helping those providers better engage with patients, whether that’s through medical attention, or addressing social determinants of health needs.
Reaching those patients and caregivers sooner and developing stronger referrals to end-of-life care involves building a relationship with them that hospices don’t always have the staffing resources to facilitate. We try to be that bridge, that facilitator and not only be the family’s point of trust, but also bring in the providers that offer supportive services.
It’s almost as though we’re the detectives that help provide better engagement and more impactful dialogue that helps with quality serious illness outcomes.
How do you think the end-of-life care space is evolving, and where do you see hospice fitting into Acadian Health’s future goals?
We’re focused on giving people access to equitable care, be it in the home or in the hospital. With our hospice partners, it’s about focusing on the fundamentals of improving access to safe, quality and reliable care. We help be that patient or family’s advocate so that they understand the core characteristics that apply to hospice and how they may or may not fit into that seriously ill specific population.
It’s paramount to provide these family caregivers with the information they need so that they can build those care relationships effectively and support patients with a whole-person approach.
Our return on investment is having patients and families be able to self-manage at a higher level of efficacy and quality. It’s leading behavior changes around emergency utilization to have better cost and quality outcomes. Engaging with providers gives them more resources with less cost. We’ve had a high success rate of preventable emergency events happen in the home just by creating sustainable behavior changes with patients.
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