The health care realm is changing, and hospices must change with it. This is the central thesis that underlies the National Partnership for Healthcare and Hospice Innovation, which is currently celebrating the 10th anniversary of its founding.

NPHI seeks to put nonprofit hospice organizations at the forefront of innovation, the development of new care and payment models and collective action to expand access and prepare for a value-based future. The organization currently has more than 120 members, all nonprofits, who collectively care for more than 580,000 patients.

Hospice News spoke with NPHI CEO Tom Koutsoumpas about how the organization came together, its methods for fostering innovation and the actions it takes on crucial issues facing hospice providers today. 

Can you tell me a little bit about how NPHI came into existence? What’s the organization’s origin story?

Our real focus initially was on innovation. A little over 10 years ago, I had gotten together with a number of CEOs from leading nonprofit community-based programs throughout the nation, and there was a lot of concern about the changing environment that we’re in and the need to make sure that we were at the front end of thinking about innovation.

There was also a concern of being able to work with the health systems of the future. And there was also concern that there wasn’t really a forum for innovation, for discussing innovation, for looking at new approaches to care delivery. We, particularly community-based nonprofit programs, are not part of a large system or a large chain that often has exposure to a lot of different approaches throughout the nation.

Community-based programs are in their communities and that’s what their focus is. So how could we create something that would allow them to come together, to be at the forefront of learning about innovation, learning about the future, thinking about new approaches to care delivery, thinking about expanding their own models within their communities?

That was really the beginning of it, and it really grew from that moment forward. We called it the Innovation Group, and they asked me to lead it and pull it together. What we recognized very quickly was that there’s such camaraderie and collaboration among leaders of community-based programs, and we suddenly had this venue for exchanging information, exchanging ideas.

Given my role here in Washington, I could sort of see what was happening from the [U.S. Centers for Medicare & Medicaid Services (CMS)] perspective, but also from the health care arena in general, and was able to bring that information back to everybody. We created workshops around it, created discussions around it, looking at new models of care.

What are some of the key initiatives that NPHI is working on now?

There are many. We have really focused on, not just on hospice, but making sure that we can be part of the continuum of care delivery. So many of our programs, they all provide palliative care. Many of them are providing home-based primary care and looking at expanding those services. My vision has always been that we could begin to care for patients much earlier in the trajectory of their illness, as they advanced in age and advanced in illness, but that it wouldn’t be just at the very end of life.

The goal with primary care is to begin to do that at that earlier point, and then you can care for them all throughout to the end of life, so that the family and the patients have the opportunity to have a provider skilled in that sort of care delivery. They never have to worry about it from that earlier point on, and all of our programs are really striving to get there.

We also are doing a lot of other things. We have created the Cancer Care Guide. We’ve created a dementia guide. We’ve created a heart guide for caring for cardiac patients. We’re working on a veterans’ initiative. We have many different kinds of initiatives that are all important for our providers, but most importantly for our patients and families.

Can you tell me about some of NPHI’s benefit reform efforts?

I want to make sure we’re never at the back end of the future, and that we’re at the front end of the future, and that, as we see the ever changing landscape of health care, we are always one step ahead of it.

As we look at value-based care, and we look at the goals of CMS to convert everything into the value-based care delivery model, we at NPHI want to make sure that we participate in that, make sure that we’re not left out of that. So we’re working on modernizing the Medicare Hospice Benefit to fit with that future.

We’re really working hard to look at a design that would preserve the care delivery components of hospice, which are so critically important in the focus and mission of our work, and fit it into the value-based approach. It’s really about payment reform, so preserving the care model and the importance of the integrated team-based approach, but doing that with a different payment structure.

What would you say are some of the biggest challenges facing nonprofit providers right now?

Certainly, there’s always the rate issues. We are caring for more and more very complex patients. That’s certainly true with our dementia and Alzheimer’s patients, which, if you look at that demographic alone, and the number of our future patients that are going to be suffering from Alzheimer’s and dementia, it’s extraordinary. But we have a lot of very complicated patients, cardiac patients, cancer patients, etc., and the rate doesn’t keep up with the care delivery cost. Cost issues are always of concern.

Then there’s just so much more competition with large for-profit systems that, because of their scale and their approach to care delivery, can be very challenging. That’s part of why we came together, initially through innovation, through the innovation approach, but also the opportunity to bring nonprofit, community-based, like-minded programs together to create some scale and allow that scale to address cost issues.

We have a purchasing group. We really work hard together to make sure that we try to mitigate some of the cost issues by using that scale.

The other thing that we do is provide all the levels of care. We lose money generally on inpatient care, but our programs provide it because we know that it’s so important for patients and families in our communities. Many of the competitors don’t do it, even though that’s against the regulation. So we lose money in programs like that, but we’re committed to them because of the right thing to do.

Our members reinvest every dollar back into that care, and the bottom line has always been an issue for them, but they’re always going to be like that. They’re committed to putting every dollar back in to deliver that high quality care to patients and their families.

Unfortunately, in some states anyway, fraud and abuse are rampant right now. What is NPHI doing on that front?

We’ve been working with CMS to identify it, and we’ve been really supportive of them to bring to their attention where our programs see serious issues. For instance, in California, in Nevada, in Arizona, we were very proactive at making sure that the CMS and the [U.S. Department of Health and Human Services Officer of the Inspector General (OIG] were aware of what we saw and suspected as really fraudulent activity.

When you start seeing in your community 40 programs registered at the same address that happens to be a store in a mall, then there’s something going on there. But unfortunately, CMS didn’t recognize that. Unless you’re in the community and seeing those things firsthand, it often gets overlooked.

We actively have participated with CMS and the OIG on that, and we continue to do so. We’ve met with them in different communities where we suspected these issues, and we accompanied them on some of their site visits. We continually interact with them to make sure that we’re working together.

For us, you know, particularly those of us who were at the beginning [of the Medicare Hospice Benefit] — and many of our program leaders were — it’s really painful to see fraud and abuse in this benefit that we believe in and we love. I can’t think of anything worse than fraudulent behavior in caring for dying people. It defies every fabric of human decency.

We are really actively engaged, and we will continue to be going forward, if we see or suspect anything, we make sure that [regulators] are aware of it and that we work with them to make sure it’s addressed.