The seed for Texas-based Pallicare was planted at a chance meeting at a 2021 conference between Jonathan Fluhart, a management professional with a background in aerospace, technology, and hospice industries, and nurse practitioner Tiffany Hughes. 

Hughes outlined to Fluhart her industry’s need for home-based palliative care, and after a number of communications, the two agreed to join forces to address the gap in services, with Fluhart’s business background complementing Hughes’s practical experience. As a result of their joint efforts, PalliCare became the first company in northeast Texas to offer community-based palliative care.

The organization currently employs nurse practitioners, physicians, nurses, and other specialists who provide in-home care services for patients with serious illnesses.

Palliative Care News caught up with CEO Fluhart, who credits Hughes’s vision for the company: “She recognized this need early on in her nursing career and became an advocate for palliative care but didn’t understand how to start a business. She approached me with the idea, and after a good bit of brainstorming we felt we had a good-enough game plan to step out of our daily roles and embark on this journey,” Fluhart told Palliative Care News.

Palliative care is often seen as a loss leader, but Fluhart and Hughes saw it as an opportunity. Hughes wanted to remedy the regulation and overworked nursing staff common to home-based care industries. In addition, she proposed to provide home care for patients who did not qualify for hospice, offering services 12 to 18 months before hospice started. PalliCare, the partners also decided, would not rely on larger organizations.

“Being fully independent opened up all the doors needed to increase our revenue into the sustainable black within 2 years of our launch,” Fluhart said.

This flexibility and institutional neutrality allow PalliCare to work with many different communities, including those in rural areas. In fact, Hughes refers to the company as “the Switzerland of health care,” according to Fluhart.

After hiring their first nurse, Shayla Rowley, who is now COO, the team had plenty of knowledge about the home health and hospice aspects of Medicare Part A, which they used as the basis of their operational model. They quickly ramped up on Medicare Part B, physician care, and used it to create their service lines and billing codes.

Fluhart likens their current operational model to a “custom hot rod, with an interior like hospice, riding on a home health chassis powered by a physician’s clinic engine. Once we established the vehicle and gathered a few amazing angel investors, Tiffany and Shayla saw patient number one, and we’ve never looked back.”

Hughes was laser focused on creating a healthy space for nurse practitioners, who reported a preference for home care. The resulting program, Fluhart says, “allowed them to autonomously practice medicine in the home, have scheduling flexibility for a healthier work/life balance, and not bearing the load of the back-office minutiae of the Part B billing world and healthcare complexities in general.”

PalliCare nursing staff have next-to-no turnover.

Since its inception, PalliCare has continued to experience growth. After 20%–25% growth each month in 2023, Fluhart reports that since last year, the patient population has increased by 98%, and revenue has doubled. The company has also expanded from northeastern Texas into Houston and southern Arkansas and, through partner alliances, has moved into Arizona and New York. The future is bright, with expansion into Oklahoma and Colorado coming in 2025.

“We can literally customize a palliative program to achieve focused outcomes alongside any established patient population. This has been hugely appealing to physician-led accountable-care organizations and home-health/hospice groups alike,” Fluhart said.

Marketing is another strong suit for the company, and Fluhart cites Chief Growth Office Molly Little as the force behind the expansion.

“[She] has done a stellar job establishing referral partners with existing patient population needs. This allows us to grow without the cost or need of traditional advertising. It’s all about relationships,” Fluhart told Palliative Care News.

With these innovations setting up further growth for 2025, the organization is looking for financial partners to scale up its services. Fluhart looks forward to the challenge: “2025 will prove to be unique for us as we begin seeking out financial partners to help us take PalliCare to the next level.”