Palliative care providers are expanding their reach across the health care continuum in an effort to better support unmet needs among seriously ill patient populations.
Patients with longer serious illness trajectories face myriad challenges related to their emotional, spiritual and logistical needs that are often unaddressed as they seek curative treatment. The issue can result in high emergency care costs, increased barriers to access and poor quality of life, according to Tesha Walker, director of hospice at Primecare Hospice, part of Flournoy Health Systems.
Palliative care collaborations have increasingly cropped up in hospitals, skilled nursing facilities, assisted and senior living communities, as well as in community-based settings. Driving the trend is growing recognition of these services’ value proposition to reduce health expenses and improve outcomes, said Walker during the Hospice News ELEVATE conference.
“As we start to really look at where we’re going with some of the changes that are taking place, we can have better outcomes, a better outlook,” Walker told Palliative Care News at the conference. “I’m excited to see where things are going with the realization that we don’t have the same patients. When you have a good, structured palliative care program in place, it reduces hospitalizations. That means we actually can see the revenue and reimbursement rates. From a provider standpoint, we really start looking at having these robust, structured programs in place.”
Wide variations exist when it comes to the scope of palliative care services across the country. Some palliative care programs offer a full range of interdisciplinary services that address physical, emotional, spiritual and psychosocial needs. Other programs offer advance care planning and palliative consultative support.
The lack of clear, consistent service definitions has challenged the ability for palliative care programs to grow, said Dr. Ben Thompson, national medical director for workforce development strategy at Gentiva. The company provides hospice, palliative and home health care across 38 states.
Having a structured regulatory framework around palliative care delivery could go a long way toward building better payment and access pathways, Thompson indicated. However, careful consideration must be given to community- and geographically-specific population needs, he said.
“What we have to do is define what a palliative care program is,” Thompson said during the conference. “There are no national standards for what goes into a palliative care team. What is it that we need in order to make the most effective, highest quality palliative care team? That’s not going to be the same for every geography. We need to work on defining those things, and then we look at where the partnerships come in with insurers, even in the fee-for-service palliative care world?”
The ability to demonstrate quality improvement is key for today’s palliative care providers, according to Rikki Hooper, chief clinical operations officer at Four Seasons. The nonprofit provides hospice and palliative care in North Carolina.
Having strong quality and cost outcomes can open doors to new referral streams and support palliative care program growth across different health care settings, Hooper said during the ELEVATE conference.
For example, health care providers have increasingly sought ways to improve quality of care for patients with cancer and dementia, she said. More patients are living longer with these conditions, often with comorbidities and varying levels of high need at different stages of their illness trajectories.
Hospice News photo by Merz Photography Hospice News photo by Merz PhotographyPalliative care integration can play an important role in addressing a wide range of seriously ill patients’ acute and chronic care needs, according to Hooper. Unlike hospice, patients do not need to forgo curative treatment in order to receive palliative care. This factor represents an opportunity for increased access, particularly for patients with complex and unpredictable conditions, she stated.
Palliative care programs seeking to expand across the continuum need to creatively and intentionally strategize the best utilization of their clinical and non-medical resources, particularly amid prolific staffing shortages, Hooper indicated. Effective and sustainable growth will involve the ability to prove cost reduction and improved goal-concordant care outcomes, she said.
“There is that exacerbation in this up-and-down [cycle] where people can be on the brink several times during their 10- or 15-year course of disease,” Hooper told Palliative Care News. “If you are able to provide goal-concordant care for your patients, then that is a satisfier for providers. We have to really look at which parts of our palliative care team are most important for them at those times. We’ve got to have workforce multipliers. We have to be able to leverage other disciplines. And the reality is that all takes money.”
