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Staffing, public awareness and value-based payment represent the greatest disruptive forces shaping palliative care delivery in 2024 and beyond.
Workforce shortages exacerbated by the pandemic are a significant challenge in palliative care delivery, according to Catherine Campbell, president and CEO of Carelon Health. Carelon is the health care services brand of the insurance company Elevance Health (NYSE: ELV). Carelon Health serves an average of 15,000 to 20,000 patients across 40 states through its palliative care program, Campbell said at the Hospice News Palliative Care Conference in Tampa, Florida.
A competitive and limited supply of health care professionals is challenging palliative care providers’ ability to recruit and retain a sufficient workforce, according to Campbell.
“When I think about the staffing issues and just some of the career burnout, and how to really attract and grow our specialty area of palliative medicine, we have a lot of forces working against us,” Campbell told Palliative Care News at the conference. “There are a lot of specialty areas within medicine. How do we attract nurse practitioners, physicians, social workers and other interdisciplinary team members? How do we keep them motivated doing some of the hardest work in the practice of medicine today? There’s a lot of stress in a position [of] providing palliative care. To me, that’s my number one, top of the funnel, because everything flows from that. That’s going to be a key force, an issue that’s going to shape where this industry goes.”
Though the pandemic has had lasting impacts on the ability to recruit and retain palliative care professionals, the outbreak also shed some light among the public around serious illness care options, according to Nick Westfall, chairman and CEO of VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE).
Miami-based VITAS provides hospice and palliative care to about 19,455 patients daily across 14 states and in the District of Columbia. VITAS in 2023 cared for more than 12,500 palliative patients, Westfall stated.
Spread of a deadly virus helped bring greater attention to palliative care in the public and health care provider arenas, Westfall said. Though misconceptions persist, the needle has begun to move forward, he added.
This is also a time of innovation in palliative care delivery and community education, according to Westfall.
“It’s encouraging to see the evolution of the care itself being very patient-focused and helping people understand and educate along that continuum as opposed to maybe six to eight years ago,” Wesftall said at the conference. “Now it’s really being an integrated approach.”
Lagging reimbursement streams are among the biggest headwinds palliative care providers face in sustainable and scalable growth, Westfall indicated.
Value-based payment models offer palliative providers the greatest opportunity in terms of sustainable reimbursement, but providers must have the collaborative payment mechanisms in place, he said.
“Providers that have practitioners and the care models and are able to partner with entities that are either taking risk or responsible for managing lives, the consolidated total cost of care reduction has enough economics in it to fund this …” Westfall told Palliative Care News. “Fee-for-service is a dead business model for palliative care. Value-based, some risk-based piece, is the only way it works, but it all starts with having the people.”
Value-based care’s impact in the palliative landscape is reverberating past payment points and into referral streams, according to Peter Brunnick, president and CEO of VIA Health Partners.
“The disruptive force for us is what we have seen through our experience in these evolving payer models,” Brunnick told Palliative Care News at the conference. “And that is that a traditional hospice and palliative care organization is not positioned well in a world of attribution or world of value base, because we’re too far down the food chain.”
VIA Health’s palliative census hovers around 2,200 patients, according to Brunnick. The hospice and palliative care provider serves 32 counties in North and South Carolina.
Value-based care is affecting the scale and cost of palliative care services across the health continuum. The ability to demonstrate cost savings and improved outcomes is among the biggest levers pulling the industry forward in value-based care, Brunnick indicated.
“[It’s] really looking at what we call our palliative care service and how do we position it, model it or expand it so that’s going to align with our payer systems,” Brunnick said. “What I see as the disruptive force in palliative care is what the payers are asking us to do and what our partners are asking us to do, whether that be the hospital systems, large physician practices in a value based arrangement. What are their expectations? How do we really capture the benefits of a value-based arrangement? That’s our disruptive force in terms of how we’re evolving.”
