This article is sponsored by Vynca. This article is based on a Hospice News discussion with Dr. Darren Schulte, CEO of Vynca. This discussion took place on April 10th, 2025, during the Hospice ELEVATE conference. The article below has been edited for length and clarity.

Hospice News: We’re going to be talking about the future of palliative care and how providers can innovate with technology. I’m pleased to introduce Dr. Darren Schulte, the CEO of Vynca. Would you introduce us to Vynca and tell us about the work you’re doing?

Dr. Darren Schulte: Vynca is a healthcare services and software company. We provide palliative care to individuals currently living in the Western United States, in five states, including California. We’ve cared for 15,000 individuals with serious, life-limiting illnesses over the10 years we’ve been practicing. We also have software that we offer to health systems for advance care planning, so you can digitally create, store, and share advance care planning documents integrated within your electronic medical record.

HSPN: So, a very wide-scoped question: how would you characterize the current state of palliative care in the United States?

I would say palliative care is misunderstood, underused, and not easily available to those who need it. From our perspective, the providers and patients generally have a lack of awareness and education. They think of palliative care as only hospice care. Palliative care, the way we think of it—because we are not tied with a hospice—is for those with serious illness who can benefit from an improvement in quality of life. We work alongside their treating physicians, who normally don’t have the time to attend to symptom management, pain management, and goals of care. Those are the things that are important for people living with these serious illnesses.

Only 13% of patients (and their caregivers) have any knowledge that palliative care even exists. When I tell people what our company does, they’ll say, “I wish my grandmother had that opportunity.” Palliative care is really there to help ensure goals of care, improve quality of life and eventually transition folks into the next part of their journey, which often is hospice.

Another interesting piece of palliative care is the lack of reimbursement models. We often see palliative care being provided by those who are also providing hospice, which is great—but those are hospice providers. We don’t see as much as we’d like to see in terms of specialty palliative care.

There are 13 million individuals in the United States—adults—who could benefit from palliative care, and about 700,000 kids, according to CAPC. Only about 15% of that population is getting any sort of palliative care. The last thing I’ll say is most folks, even if they’re aware of it, think of it as being in the inpatient setting, not the outpatient setting. At Vynca, we focus on outpatient, community-based palliative care, which is so critical to solving the access challenge.

What would you say are some of the leading headwinds and barriers for palliative care providers in 2025?

Number one, two, and three is lack of adequate reimbursement.

Palliative care does not have a Medicaid or Medicare benefit. It’s paid on a fee-for-service basis. Only a few states offer palliative care under their Medicaid benefit. California is one. Hawaii, most recently, is another. So that really limits the availability of high-quality palliative care. It’s often provided by health systems—often academic medical centers—locally, or by home health and hospice companies, sometimes as a way of ensuring a funnel into their hospice.

Now, health plans will pay for high-value palliative care. But that means you must have contracts and partnerships with health plans. It’s not something where you can just sign up Part B Medicare patients and get a fee-for-service reimbursement. In that case, it’s just not adequate.

The other headwind, in addition to lack of reimbursement, is what I mentioned earlier: lack of education, lack of awareness. If providers aren’t aware of this, they’re not referring patients to palliative care providers. And if patients aren’t educated on the options, then both groups are missing out—even if there are high-quality palliative care providers in the communities where these patients live.

How can providers leverage technology to help address or mitigate some of these concerns?

Technology is key. Certainly, at the core, it’s the patient-provider relationship and the ability to provide care that’s convenient and accessible. If you think back to what we said about reimbursement challenges—health plans are willing to pay for value, but they need to see the outcomes. They need to understand the benefit.

Where technology comes into play is in leveraging data. Data about the patients, their care—what can be done, in what situations, and what outcomes can be demonstrated to the payer.

Now, certainly, there’s technology that can be used not simply to take in data and understand what to do with it, but also to provide a better experience for patients. Patients want to have care in their homes. They don’t want to go to a clinic. Home-based care, though, is something that—without technology—you’re just driving around providing a lot of home visits. I don’t know that any organization can make money doing that under any circumstance.

Technology enables a hybrid approach—meet the patients where they are, provide care in person when needed, and virtual care when it is useful. A lot of our patients really like virtual visits. They can have their son or daughter or caregiver on simultaneously with them, and they don’t have to host anyone in their home.

Technology can help with remote monitoring, like we do for our heart failure and COPD patients. Stepping on a scale and checking your pulse oximeter is really important to understand if you’re going to have an event that might lead to an ER visit. Technology helps us understand data—algorithms can determine rising risk and acuity—so we can be proactive with care instead of simply scheduling when convenient.

Technology also helps us understand the health plan population who is most eligible for palliative care—so we can be more proactive in enrolling patients, not just waiting for referrals.

Finally, our providers want to provide clinical care, not administrative tasks. The more you can automate and orchestrate activities, the more you enable care to be delivered—and the more likely you are to retain your staff. There’s a huge shortage of high-quality providers. That’s where we think technology plays a role—for both the patient and provider experience.

And how can providers use technology to take palliative care delivery to the next level?

For us, the mission is to enable more quality days at home. A quality day at home means you’re not in the hospital or ER.

When we talk about data, it’s about understanding and predicting when there’s a need to visit patients and care for them, instead of just visiting on a fixed schedule.

So what can data and technology do? Nudge patients—“How are you doing today?” We talked about remote monitoring—what does that data show? What were your last observations? What were notes from your other providers? Integrating all that and saying, “There might be a high likelihood of decompensation,” or some event. So we visit—virtually or in person—to help manage symptoms or pain and avoid hospitalization.

That’s the next level—someone asking you every day how you’re doing and intervening when there’s an issue. That’s different data, and different techniques—whether AI or otherwise.

The next level is also automating tasks—like orchestrating members of the palliative care team. It’s not just physicians and nurse practitioners. It’s also social workers, community health workers, RNs, MAs. You need technology to coordinate who is doing what, when, and for whom.

Off-the-shelf EMRs aren’t adequate for home-based care. Off-the-shelf practice management systems aren’t going to get the job done. So it’s not just data analytics—it’s orchestrating care delivery so you’re not relying on email, Slack, or text messages. And then automating so clinicians aren’t also billing or doing admin. Data analytics and technology help ensure patients get the right care at the right time along their journey.

How can patients benefit from further integration of technology into palliative care operations and workflows?

Number one: patients in rural and underserved settings may actually get palliative care. If you make them go to a clinic 20 or 30 miles away, they’re unlikely to go as often as they should.

Then there’s convenience—nudging them, asking how they’re doing. If we see they’re increasingly short of breath, or we detect another concern, we can reach out. So it’s convenience, accessibility, care when needed. Without technology, you’re just driving around to people’s homes whenever it’s convenient—not when it’s needed. That’s the model without tech. Technology helps caregivers and practitioners do what they do, better.

With interoperability standards—post-Meaningful Use—there are now many health information exchanges (HIEs). That data goes from EMRs from practitioners. With the right technology, you can access that.

When a patient is enrolled in our service, the first thing we do is ping an HIE, pull down the medical records, and analyze them. You can do that with people or machines. You can access pharmacy data—it’s widely available through SureScripts and other means. Clinical data is far richer than claims.

Now, claims do give you utilization. How often have you been in the ER or inpatient setting in the last six months? That’s important. How many medications are you taking? If you’re not getting that from an EMR, you can get it elsewhere. That helps us assess risk for near-term events.

Diagnoses in claims are old and not granular enough. They won’t tell you NYHA Class III heart failure, or cancer stage and grade.

So how do you get claims data? You need a relationship with the health plan. When we do contracting, we say: we need the claims to understand who’s eligible. We don’t rely on health plans to tell us who’s eligible—eligibility is a clinical exercise.

We use the data to determine outcomes—typically we have at-risk, value-based arrangements. Without claims, we can’t report on or evaluate outcomes. So under those arrangements, the plans say, yes, we’ll give you the data.

Under a fee-for-service arrangement—you won’t get claims. You’ll be treated like any other provider. No cardiologist gets claims from a health plan. So under fee-for-service—there is no chance. You need a deeper relationship.

While supporting the advance care planning software, Vynca consistently observed a lack of palliative care in the communities they served to meet the needs of patients and families. To learn more, visit: https://www.vyncacare.com/about.