As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses.

The World Health Organization estimates 56.8 million people need palliative care annually, worldwide. However, only about 14% of people who need this care receive it. While the need is growing, palliative care can be treated by some as a niche product, a boutique health care service lacking spread-sheet-ready benefit for its patients.

This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space.

When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. While selling the idea of a palliative care service in and around Texas, they found few sympathetic ears.

“Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.”

They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors.

“We had a physician that Tiffany had worked with for a while. He’s a hospitalist, and they always talked about palliative care. We went and had dinner with him and talked about our plans and thoughts. He was the first person to put up some capital,” Fluhart said.

A little more than three years ago, this connection helped them raise about $650,000, enough to start the operation and get patients in the door. 

Fluhart says by December 2022, the company was profitable and has stayed that way ever since. 

“I call them ‘angel investors’ because they were all people of a smaller community that saw what a huge gap there was in patient care,” Hughes said. “The palliative space is just so new and such a new frontier. I was so appreciative that they were so passionate about the cause that they invested their hard earned money in it. I’m so grateful that we were able to prove everyone right.”

PalliCare has about 1,000 active patients today, among the more than 6,000 patients served so far.

Another rapidly growing palliative care business is Indiana-based InHome Connects, which launched in 2022. According to Vice President of Palliative Programs Rebecca Doleman, the multistate provider (it is for-profit in two states, nonprofit in one) is the brainchild of a single person. 

“(It was) the forward-thinking insights of our owner and investor to be willing to spend the money to help build the program to get us where we are now,” said Doleman.

Once up and running, energy at InHome shifted to creating a sustainable model. It has not been an easy sell, Doleman said, with payers proving to be a stumbling block. 

“The focus to scale with contracted payers is a priority and our number one challenge. Where there is a need to engage the market space at the payer level, the access to do that, the understanding and the willingness for the payer to stay at the table and negotiate, continues to be the biggest barrier in the market space,” Doleman said.

InHome finds payers often are uncertain about the value of palliative care, and are unclear on the best way to quantify it, Doleman said. A lack of familiar, precise data points can make it difficult for some payers to buy in.

“Getting our proof of concept and some objective data to stand on in these subsequent conversations with other interested payers have been essential,” Doleman said.

Fluhart and Hughes treat their palliative entity like any medical specialty, no different than an oncologist. This has allowed the for-profit Texas company to continue to grow as it finds payers willing to pick up patient expenses.

“We bill on a physician’s fee schedule just the same as your doctor or your PCP. It’s really not a hard sell to anybody to pay for it, if that makes sense.” Fluhart said.