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Palliative care has been one of the largest growing segments of the health care industry in the last decade despite challenges such as staffing shortages, reimbursement headaches and misconceptions regarding this type of care.
According to the World Health Organization, each year, an estimated 56.8 million people need palliative care. Worldwide, only about 14% of people who need this care currently receive it.
Demand is rising, driven by factors such as the aging population, growing demand for comfort and quality of life and integration with other health care facilities.
On the flip side, factors challenging this market are high costs of treatment and fragmented delivery models, which can result in subpar care coordination providing patients with less-than-ideal outcomes.
Integration key to success
Tiffany Hughes, chief operating officer of Texas-based PalliCare, found that the secret to a successful palliative care model is creating a continuum of care between home health and hospice for patients within the last 18 to 24 months of life.
“Patients who aren’t quite ready for hospice still need care but there is no seamless transition between home health and hospice. There is a gap that patients often become stuck in,” Hughes told Palliative Care News. “I knew that if we could put a nurse practitioner with a patient earlier in the prognosis, they would move through the continuum of care with that patient and create a report. Physician groups are our biggest referrers and send us patients at 18-24 months. While physicians see their patients in the clinic, we see them in the home and we are the other side of their patient’s care.”
Similarly, Rebecca Doleman, vice president of palliative care programs for Indiana and Texas-based InHome Connects (IHC), said their business model revolves around delivering palliative care services in markets that align with their existing hospice footprint. InHome Connects is the palliative care arm of Heart to Heart Hospice.
“Our primary objective is to cultivate direct contacts with payers within these markets. We have strategically launched fee-for-service (FFS) initiatives in key locations, showcasing our care model’s emphasis on integrating clinical and social support to address the diverse needs of our patients,” Doleman told Palliative Care News. “Our program is staffed by nurse practitioners and social workers, under the oversight of our medical director. This collaborative approach enables us to offer comprehensive care tailored to each patient and their family, ensuring that we identify and address their specific needs effectively.”
Embrace the risk to reap the reward
Even with a solid business and care model, launching a startup can be risky.
One of the most significant hurdles to success is inadequate reimbursement. This is particularly pronounced in outpatient settings, where the disparity between billable and non-billable services can be stark. Essential roles such as social workers, case managers/care coordinators and chaplains often do not generate billable revenue within an FFS business model, despite their crucial contributions to care outcomes and return on investment.
Moreover, the cost of employing billable providers is considerable, further exacerbated by the ongoing challenge of aligning productivity requirements with salary expenses within a strictly FFS billing framework. To address this, providers must staff ancillary roles to support higher billable volume, albeit at the expense of narrower profit margins month over month
Doleman offered that recognizing that profit margins in the palliative care field can be minimal is essential, even under the most favorable circumstances. Whether operating under an FFS or a per-member-per-month model, the sustainability and scalability of these programs hinge on prudent financial management and well-informed business decisions.
“Identifying and prioritizing engagement in areas with established, quality relationships and receptive partners is crucial,” Doleman said. “The success of the venture heavily relies on the depth of community networks and securing external support from key partners.”
Community partnership, flexibility, education
Hughes noted that to roll with some of the biggest obstacles, it is important to be willing to pivot, be creative, accept new opportunities, and always keep an eye on growth.
Doleman echoed that thought, stating “flexibility is key in accommodating the preferences and priorities of each payer or partner, recognizing that these vary widely across different healthcare systems.”
“The essence of palliative care shines brightest when we tailor our approach to serve our partners and payers with the same level of dedication we offer our patients,” she added.
