Supporting seriously ill children and youths can come with higher costs and greater complexities compared to adult populations. Sustaining pediatric hospice and palliative care programs involves employing dynamic referral and financial strategies in today’s health care landscape.
Pediatric programs often face challenges when establishing a firm financial foothold, with funding a main obstacle hindering growth and improved accessibility, according to Dr. Rebecca MacDonell-Yilmaz, medical director of pediatric supportive services at Rhode Island-based HopeHealth.
Thriving in the pediatric hospice and palliative space takes strong philanthropic funding, as well as demonstrating the value proposition of these programs in the payer landscape, MacDonell-Yilmaz said during the Hospice News ELEVATE conference in Florida. A strong sticking point is that pediatric hospice and palliative care services can reduce high-cost and burdensome care when offered concurrently with curative treatments, she stated.
“We try to partner a lot with our payers to help them understand that, just like an adult palliative care and hospice, this really can decrease hospitalizations and overall save money,” MacDonell-Yilmaz told Palliative Care News at ELEVATE. “So, [it’s] really taking that extra step to have conversations, to help them understand [that] the payer mix is less than ideal.”
Hospice News photo by TBAR Productions Hospice News photo by TBAR ProductionsAddressing referral complexities
HopeHealth has been growing its pediatric hospice and supportive care service lines to address a broad range of unmet needs among seriously ill children and their families. HopeHealth in 2021 began providing inpatient and community-based pediatric palliative and hospice care to infants, children and young adults. MacDonell-Yilmaz has played an important role in helping to establish these services.
Established more than 50 years ago, the nonprofit health system serves Rhode Island and southeastern Massachusetts. HopeHealth provides home care, hospice, palliative and dementia care, as well as caregiver and grief support services.
HopeHealth partners with the LifeSpan Health System’s Cancer Institute and Accountable Care Organization (ACO), as well as Rhode Island Hospital, The Miriam Hospital, Newport Hospital, Coastal Medical, Brown Medicine, South County Hospital and Sturdy Memorial Hospital. HopeHealth is also a hospice and palliative medicine teaching affiliate for The Warren Alpert Medical School of Brown University.
The health system has seen rising demand for pediatric support both in the hospital and home settings, according to MacDonell-Yilmaz. In addition to her role at HopeHealth, she also serves as a pediatric palliative care physician at the Hasbro Children’s hospital in Rhode Island, part of Brown University Health.
Education and collaboration is a significant part of building lasting referral relationships in the pediatric hospice and palliative care realm, but often an ever-present battle, MacDonell-Yilmaz stated. A large barrier is helping referrals understand that these services can be offered concurrently alongside curative treatments. Effectively communicating this point is the most important part of having a strong referral base, she indicated.
Hospice News photo by TBAR Productions Hospice News photo by TBAR ProductionsReferral partner education can be strengthened by reaching pediatric professionals further upstream in their careers, according to MacDonell-Yilmaz said. This involves providing exposure to pediatric hospice and palliative care throughout their education and career pathways. Collaborating with medical fellowship and residency programs at hospitals with pediatric programs is one tactic to expand awareness among the next generation of clinicians, she added.
Having new clinicians gain experience through pediatric hospice and palliative care rotations can provide a deeper understanding and knowledge of the benefits of these services when it comes to providing goal-concordant care to families, MacDonell-Yilmaz indicated.
“It really comes back to education,” MacDonell-Yilmaz told Palliative Care News at the conference. “Education [for] other clinicians about what concurrent care is, that might be appropriate for their patients, that doesn’t mean they’re right at the end of life. Palliative care extends along the spectrum. Here’s some support we could bring in earlier on to really wrap our arms around this family and make this a better experience. I find that I still do a lot of education with other referral sources and partners in the community to help them see that this is a really great option for children.”
