Florida-based Alivia Care Inc. has launched a new suite of home-based services that includes a three-pronged approach to helping seniors age in place.

Dubbed Alivia Care @ Home, its services include home health, private duty and supportive care (community-based palliative care). Featuring these three service areas was key in designing a care model aimed at meeting patients’ individualized needs, according to Susan Ponder-Stansel, Alivia Care’s president and CEO.

“Patients may need all three components of care at home, supportive care and non-skilled or private duty services, or they may need only one,” Ponder-Stansel told Hospice News. “We tried to develop a flexible approach so that patients don’t have to fit into our system, and we could really tailor care to fit their needs and meet them where they are. This is a piece of the puzzle of creating that continuum of care where we have a whole suite of services and support for people with serious and advancing illness.”

Alivia Care emerged in 2020 when Community Hospice & Palliative Care, now an affiliate, formed a larger company with a broader range of services. The nonprofit provides home care, hospice, advance care and supportive and palliative care across northern Florida and southern Georgia. Alivia Care also offers care coordination through its Programs of All-Inclusive Care for the Elderly (PACE) services.

Through Alivia Care @ Home, the nonprofit offers rehabilitation (occupational, physical and speech) therapies to homebound patients in community- and facility-based settings, such as assisted living facilities. The services also include palliative care consultations, pain and symptom management and transitional care.

Service diversification has been a longstanding part of Alivia Care’s growth strategy to meet the evolving needs of a swelling aging population, according to Ponder-Stansel.

Seniors 65 and older represent 21.6% of Florida’s population and 15.1% of Georgia’s, according to the U.S. Census Bureau. This age group is anticipated to grow by nearly one-third by 2045, the Florida Department of Elder Affairs reported .

“We want to differentiate ourselves with a competitive advantage in our market,” Ponder-Stansel said. “We want to help patients, their families and our referral sources to understand that we don’t make them figure out which program is needed, that we have care navigators and a ‘no wrong door’ approach to services that really can benefit them.”

Developing the home-based services will help to address gaps of unmet needs, Ponder-Stansel said. These services will provide greater opportunities for education around disease progression and discussions around goals of care to help patients and families make informed choices around their end-of-life care options, she explained.

The new services also address patients’ nonmedical and psychosocial needs such as transportation, meals, companion support, assistance with activities of daily living (ADLs) and social determinants of health.

A large aim of the program is to keep patients in their homes and avoid expensive rehospitalizations in a fragmented health care system, according to Ponder-Stansel.

“Being able to deploy these skilled services helps with the overall management of care for these patients, and that’s going to be really important in giving them a choice of services,” she said. “It empowers patients, and that’s really missing from our health care system’s structure — it’s kind of fragmented. People are getting discharged from the hospital with home health and when it expires they’re doing it all over again, feeling worse and not getting information they need to make informed choices about their future.”

Companies seeking to build a similar home-based care program should consider the array of financial pieces involved such as navigating an entirely different reimbursement structure and the complexities of revenue cycle management, according to Ponder-Stansel.

Having a foothold in Florida’s value-based market for home health was a significant part of establishing the new service line, she stated. Another key was having a deep understanding of the different mix of payers and payment options alongside the regulatory structure of home health compared to hospice, Ponder-Stansel added.

Launching these services allows Alivia Care to have “a foot in both canoes” of services within both the hospice and home health Medicare realms to better support patients and families, Ponder-Stansel said. Helping seniors age in place is a core part of improving quality and health care cost outcomes, she added.

The decision to diversify its services was part of the organization’s strategic plans to prepare for some of the forthcoming value-based initiatives impacting hospice payment from the U.S. Centers for Medicare & Medicaid Services (CMS), according to Ponder-Stansel.

Part of the agency’s refreshed strategic goals is to have all fee-for-service Medicare beneficiaries in an accountable care relationship by 2030. The goals are designed to improve health equity, quality and access to care while controlling costs.

“This is part of our thinking to be prepared for 2030 when CMS wants every patient under Medicare to be in some sort of accountable care relationship,” Ponder-Stansel told Hospice News. “We see that coming, even in a slow and spotty way across areas in our market. We see more special needs plans, ACOs and Medicare shared savings programs at the provider levels. The approach you see in the hospice industry is headed more toward a complete suite of services so that they can take on risk and be part of value-based care when it becomes more widespread.”