An increasingly diverse base of health care providers have taken an interest in the palliative care space, a trend that could be indicative of how strategic growth is taking shape in the field.
As they build out their palliative care programs, many of these organizations are pursuing partnerships to foster coordination and growth. A range of palliative care joint ventures, care collaborations and partnerships have evolved in recent years as more health care providers work to address the needs of a swelling aging population.
More home health care, health systems, hospices and primary care providers have gained a foothold in the palliative care space, often through community-based collaborations.
Palliative care’s value proposition is gaining recognition across the continuum as more health care providers and payers recognize how these services can reduce costs and improve outcomes, according to Dr. Gavin Baumgardner, vice president and national medical director of primary and palliative care at Contessa, a subsidiary of Amedisys (NASDAQ: AMED).
“The fact that we are seeing traditional palliative care providers being joined by hospice organizations, primary care groups and hospital systems all starting palliative programs underscores that palliative principles permeate all aspects of health care and medicine,” Baumgardner told Palliative Care News. “This increase in palliative care uptake by more providers means they will be looking for expertise from palliative care interdisciplinary teams. We’re able to bring a focus on symptom management and care navigation to organizations not traditionally in the palliative care space.”
A diversifying field
Though hospices and health systems have largely dominated the palliative care market, primary care providers have increasingly delved into the space.
Primary care can often be an untapped area of opportunity for palliative growth, according to Skelly Wingard, CEO of By the Bay Health, Mission Hospice & Home Care and Hope Hospice, which recently merged.
“The most significant partnership, which is often overlooked, lies at the individual patient level between the primary care provider and the palliative care team,” Wingard told Palliative Care News in an email. “A palliative care team is equipped to provide great value to a primary care provider — both in time saved and in deeper, more intimate insights gained from an interdisciplinary team that can spend more time with a patient in a home setting to identify high impact interventions that can avoid hospital and emergency room visits.”
More primary care providers are seeing community-based palliative care as an opportunity to bridge gaps among underserved populations, such as seriously ill patients in rural regions, according to Baumgardner. The interdisciplinary team approach involved in palliative care allows for stronger care coordination and cost reductions, and also opens doors to caregiver support and advance care planning services, he stated.
Similar reasons are driving more hospitals and health systems to collaborate with palliative providers, Baumgardner stated.
Tennessee-based Contessa has been among the palliative care providers forging numerous community-based partnerships with hospital systems.
For example, the company in 2022 formed a joint venture with Mount Sinai Health System. Dubbed Mount Sinai at Home, the program offers community-based palliative care across the New York-based home health agency’s service region. Joint ventures and partnerships are a key to Contessa’s strategic plans in palliative care in a big way, the company has indicated.
“We are experiencing growth in partnerships in several areas,” Baumgardner said. “One is in our joint venture partners that are already in the high-acuity space, such as those offering hospital-at-home [care]. The health care systems are recognizing the importance of bringing palliative care at-home services to their patients in need as a significant component of the full continuum of care in the home, helping to defragment care delivery.”
Drivers of palliative growth, sustainability
The outlook for palliative care growth is “strong” and “substantial,” according to Dr. R. Sean Morrison, the Ellen and Howard C. Katz Professor and chair of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai.
The diversifying interest in the field reflects the needs of seriously ill patients at varied stages in their health trajectories, he stated. Delivering quality outcomes involves palliation, which can also create stronger touch points across the continuum to better address unmet patient needs, Morrison said.
“The multiple needs of these patients — medical, social, psychological, spiritual and personal care — cannot be met by just one health care discipline and requires a team approach,” Morrison said. “The complexity of the patient population requires a diverse team. I think the big difference over the past five years is the recognition by non-palliative care health care professionals of the benefits of the added layer of support that palliative care provides.”
Mount Sinai has increasingly integrated palliative care into its oncology, critical care, heart failure and hospitalist services, a trend anticipated to continue, Morrison added.
“At a health system level, [it’s] creating system level change so that the principles of palliative care are integrated throughout all aspects of care,” he told Palliative Care News.
The sustainability and growth of palliative care services has in part been driven by an evolving reimbursement climate, according to Baumgardner. Traditional fee-for-service reimbursement routes do not sufficiently cover the depth of interdisciplinary services in palliative care.
More value-based programs have emerged with palliative payment paths, along with various disease-specific and alternative payment models. Models such as ACO Realizing Equity, Access and Community Health (ACO REACH), Guiding an Improved Dementia Experience (GUIDE) and Kidney Care Choices (KCC) are among those gaining traction around improving palliative reimbursement.
Growth in palliative care will be driven by more promising and sustainable payment, according to Baumgardner. Interest in palliative could grow among hospice and home health companies in particular with stronger reimbursement options, he stated.
“One of the most significant factors in driving interest in palliative care is creating better financial models that allow for a team-based approach to care, rather than a solo provider approach that was supported by traditional fee-for-service arrangements,” Baumgardner said. “I suspect we will see other hospice and home health companies starting up or growing palliative care programs in the next year, but the biggest challenge to growth is having a payment system to allow for the team-based approach to care that makes these programs most successful.
Ultimately, the drive for greater interest in palliative care is tied to the shift toward a more value-based payment landscape, Wingard stated. The value-based insurance design (VBID) demonstration is among the most impactful pieces of shaping palliative payment and growth in the sector, she said.
The ability to demonstrate improved quality outcomes alongside reduced health care costs will be a key part of how growth in palliative care takes shape, Wingard said.
“Reimbursement is now not only tied to specific quality metrics, but risk-bearing entities can now benefit more substantially from cost savings — instead of handing all those savings back to the payor,” Wingard said. “Home-based palliative care is uniquely designed to keep members in their homes and realize these savings, since staying at home will always be more cost effective than a hospital or emergency room visit.”