Helios Care CEO Dan Ayres: Hospice Partnerships Drive Innovation

Helios Care is working to change the face of hospice in its upstate New York service region, with a new partnership with the Bassett Healthcare Network as a cornerstone of its strategy.

Late last year, Helios established a new kind of collaborative partnership with Bassett with no money changing hands or any change of ownership. Now, the two organizations are working together to ensure early hospice and palliative referrals, reduce hospitalizations and readmissions and build an infrastructure for lasting change.

Bassett Healthcare Network is an integrated health system that includes five hospitals, a home health agency and two skilled nursing facilities, as well as dozens of community-based health centers and school-based health centers.

In 2022, Helios Care served more than 580 hospice patients across four New York counties in addition to 90 palliative care patients and more than 550 bereavement care clients. Formerly known as Catskills Area Hospice and Palliative Care, the organization rebranded as Helios in 2019.

Hospice News spoke with Helios CEO Dan Ayres about how this collaboration came together and what these providers see on the horizon for their organizations and the patients they serve.

What is the nature of the partnership with Bassett? Is this a formal joint venture or some other type of arrangement?

This is purely a collaboration. It’s not M&A. There’s no shared governance or shared risk reward. It’s purely a programmatic collaboration to jointly improve the care for the communities we serve.

New York state is last in the nation for hospice utilization. While the counties that we currently serve are better than the rest of the state, it’s only at about 30%.

The hospitals are trying to reduce hospital mortality rates, 30 day readmissions and get better bed utilization. We can help them with that by both providing palliative care services and hospice services. If we can do a better job of identifying those patients who will benefit from hospice and palliative care earlier, that’s a win-win for both sides.

When we really took a look at both of our missions, they were so closely aligned that it was like a natural thing. But we really wanted to put it into a document with an actual work plan. There’s like seven elements to the work plan that we are committing to, part of it does include our use of palliative care.

Palliative care for us is currently being funded by the Mother Cabrini Health Foundation. But we both know that as Medicare Advantage begins to expand, and [the U.S. Centers for Medicare & Medicaid Services (CMS)] is anticipating being fully transferring beneficiaries to Medicare Advantage by 2030. So Bassett needs to be a fully integrated delivery system, and we can help them with that post-acute care, end-of-life segment of the continuum.

Their mission is curative; our mission is comfort. It’s bringing in a community-based organization to fulfill that mission without the necessary incumbrances of a different type of relationship.

Did you need to navigate a certificate of need (CON) process in relation to this?

We took this forward to the state as an innovation. I actually wrote a paper for the [New York] Department of Health about how I thought CONs should be looked at within the state. Because of the size of our counties, they should relate a certificate of need for a hospice based upon a health care network. Because in the future, as Medicare Advantage starts to contract directly with the provider, we would then become a subcontractor.

We have one county the size of Rhode Island. It’s not natural to use counties as the basis of giving certificates of need. It should be relationships, either with the health care provider or with the payer. You want to be in the same counties that either your network is in or your payer is in.

We thought the best way to have this relationship is with a health care provider in an integrated delivery system, so that they become the contracted entity with help with Medicare Advantage, and we become a provider of service that helps bring down their cost.

Because of that, the state has now given us two more counties. That’s the big news. No one can remember the last time New York State gave a CON into a hospice. The five counties that we now serve are the size of Rhode Island and Connecticut combined. And it’s rural with low population density.

Where we fit in is with that braided service coming out of the health care system. We’ve got several social workers working within the medical center with the palliative care director. We have a nurse who is embedded in the medical center, working with the staff.

We have set an operating metric of same-day admissions, or no later than 24 hours. So it’s going to take us time to be able to fully service those additional counties, because we’re hiring. And by the way, our hiring has been successful. We’ve hired three nurses so far in a short amount of time.

The way New York hospices were running isn’t working. We’re the last of the nation by utilization. The average census for hospices in upstate New York is around 30. We had to find a different way to improve hospice utilization. I’m a recovering hospital administrator, and we believe the best way to do that is to partner with a health care network, and not to be owned or encumbered by the bureaucracy of a large network. We all agreed to that. We were able to put it in writing with an actual plan with deliverables.

The state was then willing to give us a waiver to the CON. So we didn’t actually go through a CON but rather a waiver. We have a partnership with the home care agency At Home Care, which was a regulatory prerequisite. That agency is also 51% owned by Bassett.

So we have a complete workflow, where there’s actually a screening tool for patients who could benefit from palliative care or hospice, and then they refer to us. They have the physician refer to us. We go in and do an assessment. We can make recommendations that may in some cases include hospice. We’ve got about a just under a 30% conversion rate.

How did your organizations first come together to talk about forming this partnership?

I met with [then Bassett CEO Dr. Tommy Ibrahim, who stepped down effective Jan. 1]. We talked, and he saw the value.

It’s interesting; they actually have a relationship with [the UnitedHealth Group (NYSE: UNH) subsidiary] Optum. I met with one of the Optum executives and explained how this could work, and they all saw that this made perfect sense.

The differentiation I want to make is, so many times with a hospital or health system, it’s a handoff when a patient comes to hospice. It is no longer considered a handoff. We like to think of ourselves as an extension of the provider. We’re the ones in the home making the assessments. We now have access to the medical record, and so we give feedback to the attending physician. So it is really a more comprehensive wrap around the delivery model for that chronic disease patient, maybe looking at the end of life.

Now, our referrals are up, but our length of stay is not where it needs to be. So the thing we’re focusing on is that length of stay piece. We meet monthly with three senior [Bassett] VPs and the director of At Home Care, and someone from population health to go over the work plan. We’re looking at how we can improve hospice referrals, how we can reduce length of stay and admissions, wow do we reduce hospital mortality rates.

They have a thing called the Transitional Care Program. And so we’re trying to put in place a risk stratification tool that says a patient may be at risk or readmission, let’s send a palliative care consult out. We’ll take a look at the patient, make recommendations and reduce the 30 day readmission rates.

It’s been a learning process for all of us. But it’s not just a direct handoff. Now, it’s an ongoing relationship with the patient.

The other thing that we’ve been working on is aging-in-place care in the home. Through our partnership, we have now been given a federal grant through [the Health Resources and Services Administration (HRSA)] for aging-in-place care in the home. We’re looking now at how we can improve aging in place care in a rural environment, where the social network has really been diminished by the young people leaving the state for jobs.

Does Healios have similar partnerships currently, or is this the first?

This is the first and probably the only, because we are limited by our counties. We cannot fully serve another health care network in our region. The geography is too large and the population density too low.

There are overlaps of health care regions. We are not limited in our ability to accept patients from other networks, but our primary goal is to more fully service the Bassett network. The biggest factor is working like we’re on the inside with a health care network, for them to see the value of hospice and to make the referrals and make the referrals earlier. That’s the key. I mean, if we’re at 30% utilization in our counties, then we’ve got a 60% growth opportunity.

What do you know, aside from this partnership, what have been the other big developments at Helios during the past year?

We’re working with the [consulting firm] Transcend Strategy Group to target the in-home family caregivers. We have a three-pronged growth plan to market to the caregivers the collaboration with Bassett to to increase referrals out of the network and expand our service area to increase the population base that we can serve.

We’re still suffering from post-pandemic issues, turnover of physicians. There are still people who are deferring care, all those things. So we have been going through an internal reorganization and reprioritization.

While working on the collaboration literally since September of 2022, we had put the joint workgroup together even before the collaboration was signed. We’ve been putting all the building blocks in place while at the same time dealing with unusually low census. We’re starting to see the census start to come back on. It’s still small, but the positive indicators are there.