The scope of palliative care is broadening across the nation, but a lack of sufficient payment mechanisms is curbing growth. Patient data will play a key role in forming sustainable palliative reimbursement.
Calls have grown louder for a federally established community-based palliative care benefit as demand rises among swelling aging populations with a range of serious illnesses. But in its absence, providers are seeking alternatives.
Though more palliative payment avenues have formed in value-based and disease-specific reimbursement models, the momentum has not yet translated into substantial support, according to Nick Westfall, chairman and CEO of VITAS Healthcare, a Chemed Corp. (NYSE: CHE) subsidiary.
“I was hoping for federal reform, but I’ve given up hope. We have to go do it ourselves,” Westfall during the Hospice News Palliative Care Conference. “We’re going to have to come up with that through partnerships as providers and working with entities that have that information to help quantify it. And then the momentum takes off in a very substantial way that is not relying on additional funding that comes through. Maybe that comes with time, but simply capturing the funding and the share from a provider standpoint, you should be due for the care you’re providing based on outcomes. [That] is the answer, and that’s sort of been the epiphany from eight years ago to today.”
Merz Photography / Hospice News Merz Photography / Hospice NewsBuilding stronger palliative payment pathways will in part hinge on the ability for providers to pool data around quality outcomes and overall costs of care, according to Catherine Campbell president and CEO of Carelon Health.
Beyond electronic medical records, more robust types of patient data will be a part of demonstrating the cost-effectiveness of palliative care models, Campbell said.
Providers should use a two-pronged approach that includes insight into clinical documentation and claims to capture both the costs and levels of palliative care received, she explained. These data pieces are key to demonstrating cost savings and quality, according to Campbell.
“There is a payer or a client perspective of data needed in order to understand the patient population we are serving,” Campbell told Palliative Care News at the conference. “A second point is the outgoing data of the efficacy and the [return on investment (ROI)] of emergency room visits that didn’t happen and hospitalizations that were prevented because there was 24/7 palliative care for that patient. Both sets of data are really, really key. We really can’t operate, modernize and continue to evolve the palliative care industry if we don’t have both.”
Palliative care services can help reduce reliance on expensive emergency and urgent care settings while also preventing unnecessary hospitalizations, particularly as patients near the end of life, Westfall stated. The impacts of offering palliative care upstream of hospice can be “profound” in terms of cost savings at the end of life, Westfall said.
A main issue in demonstrating the value proposition of palliative care is a lack of standardized quality measures and cost structures around these services, according to Westfall.
“In order to jointly achieve what we want to occur, you have to have information on that cohort number of lives touched,” Westfall said. “The acceleration of the total cost of care reduction only comes from sharing that information. There is not a robust palliative care platform that integrates with some of the other service lines, but a lot of us providers have built out those things that allow data sharing, outcome sharing and changes in status for patients that allow us to have [the] right touch point when it’s needed.”
Various patient populations can fall into the realm of palliation need, and understanding the different conditions and associated care costs is a key to forging future sustainable payment, according to Peter Brunnick, president and CEO of VIA Health Partners.
Having data around the diverse range of palliative patients and services they need can help lay the foundation for different payment structures that better support seriously ill populations, Brunnick indicated.
“It’s taking that approach and evolving it into buckets of acuity for patients,” Brunnick told Palliative Care News. “We’re using the data to really align resources with care. The external side of it is how do we provide and show value? That’s the focus of our program today of getting claims data and being able to make that point that, ‘Hey, this really works.’”
