Hospices are taking myriad pathways toward greater service diversification. Their unique strategic approaches largely hinge on addressing the most significant needs among their patient populations.

Service diversification is more than a growing trend in the hospice space, according to Kirva Hospice CEO Cheryl Hamilton Fried. Increased upstream expansion is needed to better reach a swelling aging population with a broad range of conditions, she indicated.

Though service diversification can help drive improved outcomes and care collaboration, hospices’ approaches are often challenged by the nation’s fragmented health care system, Hamilton Fried said at the Hospice News ELEVATE conference in Florida.

“If you’re not bringing all of those services and passing people through them seamlessly, then you’re getting single service providers that are cannibalizing each other,” Hamilton Fried told Hospice News during the conference. “I have a real problem with single service providers passing or not passing on patients when they need and can be very collaborative. It’s not the right thing when you have to have a different primary care physician for hospice [and] a different primary care physician for home-based primary care. That’s disjointed care, and so we need a solution that allows people to move more smoothly through that process.”

Hospice News photo by TBAR Productions

Building blocks of service diversification

Kirva Hospice launched in 2022 by the two faith-based public services organizations Jewish Family Services and Beth Shalom. The nonprofit serves the Richmond, Virginia, region with plans to expand into contiguous markets. In addition to hospice, Kirva is in the process of stepping into the palliative care space, according to Hamilton Fried.

She recently joined the organization with more than 32 years of health care experience. Her leadership roles span across several hospices and health systems, with a background in overseeing the integration of palliative care models and other services such as Programs of All-Inclusive Care for the Elderly (PACE).

An organization’s operational and financial infrastructures are important to consider when diversifying services, according to Hamilton Fried. For instance, smaller nonprofit providers have increasingly formed affiliations designed to leverage their collective resources to support service diversification. These collaborations can help to minimize some of the financial burdens and risks, she stated.

“It’s really wise to look at what the structure is going to look like,” Hamilton Fried said. “You don’t want to start palliative care [services] necessarily under your hospice, or you don’t want to have a hospice start under a PACE program … It really needs to be well-thought out, because organizations get into significant issues related to their inability or lack of preparation and thinking about the structure of the organization.”

Hospices should carefully consider their overall mission and goals when crafting service diversification strategies, according to Dean Forman, vice president and chief strategy officer at VIA Health Partners. Established in 1978, the nonprofit provides hospice, bereavement and palliative care across 38 counties in North and South Carolina. Its additional services include pediatric, dementia and veterans care.

VIA Health Partners’ palliative program has an annual census of roughly 3,000 patients, Forman said. The organization has been building a pipeline of disease-specific programs, including a congestive heart failure program designed to ensure high-quality care coordination and caregiver support, among other goals. VIA Health Partners is anticipating the launch of a new pulmonary program in the fourth quarter of this year, he indicated.

Having an internal review process to determine the sustainability and success of a new service is a significant component of service diversification, according to Forman. Hospices need a systematic approach to understand how a new service may impact their operations, clinical capacity, billing and back-office administrative processes in addition to patient outcomes, he stated.

Hospice News photo by TBAR Productions

“Diversification has to support a strategy,” Forman told Hospice News at the conference. “Organizationally, make sure you know where that point on the horizon is, and make sure that diversification efforts are aligned behind a strategy, a vision [and] a place that you want to drive the organization to. It’s not a flavor-of-the-month type of scenario if you’re moving between diversification ideas and making changes too often. You have to evaluate if it’s not going the way it should. You have to modify, but by the same token you want to stay the course and follow that.”

Service diversification can bring three-pronged benefits to hospices including more timely access, improved referral relationships and geographic expansion, said Crossroads Hospice & Palliative Care CEO Perry Farmer. The organization provides hospice and palliative care in Ohio, Pennsylvania and Tennessee. Crossroads also provides veteran services and grief support.

Referral education is important to clearly communicate the growing repertoire of services in a hospice’s pipeline, Farmer indicated. Case in point, other health care providers often mistakenly conflate palliative care with hospice, leaving large gaps of unmet needs among seriously ill patient populations, he stated.

“What we need to do is re-educate,” Farmer told Hospice News during ELEVATE. “This is extremely important as you move forward, that you’re talking to referral sources if they’re not on board. There [are] a lot of challenges when reaching out to people and we’re talking about service diversification and starting a palliative care line. Defining what you are and what you are not is the most important. Separate what you need to look for in hospice care versus palliative services [because] trying to meld both just doesn’t work.”