Key to the Continuum: Hospice Providers Eye Primary Care Businesses

As hospice providers build out a larger continuum of health care services, some are taking a close look at the primary care space.

The term “upstream” has become a watchword in hospice. Operators are increasingly realizing the benefits of creating longitudinal relationships with patients that begin well before a six-month terminal prognosis. Consequently, many have launched additional business lines that enable them to reach patients sooner as well as capitalize on emerging value-based payment models.

A range of those models are oriented around primary care as the hub through which patients’ care is coordinated and managed, including the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) and the Guiding an Improved Dementia Experience (GUIDE) programs, among others, Alivia Care CEO Susan Ponder Stansel said at the Aging Media Network’s Continuum conference in Washington, D.C.

“We have an existing group of primary care providers, but we’re very aggressively pursuing acquiring as many primary care providers who are already in the geriatric care space, because when you look at most of the risk-based models — the GUIDE model that’s coming out and ACO REACH,” Ponder Stansel said. “[The U.S. Centers for Medicare & Medicaid Services (CMS)] believes that primary care is going to be the answer to this fragmented care problem. Primary care is where it’s at.”

Alivia Care came into existence in 2020 when Community Hospice & Palliative Care, now an affiliate, formed a larger company with a wider range of services. The Florida-based nonprofit has since expanded into Georgia and established itself in the home health and PACE arenas with plans for further expansion.

The gradual move of reimbursement systems to value-based care models is partly fueling a resurgence in home-based primary care, according to a 2018 study in the journal Geriatrics.

Patients in the United States received more than 2.2 million home-based primary care visits during 2016, up from less than 1 million in 1996, the study found. Patients in assisted living facilities, group homes, and other facilities received 3.2 million primary care visits in 2016.

A watchword for many value-based payment models is care coordination. By operating a home-based primary care program, hospices can gain an edge when it comes to coordinating services.

“One of the things that I hope we focus on is how we can really build care that anticipates the needs of people,” Ponder Stansel said at Continuum. “We’ve talked about post acute. Why aren’t we thinking about pre-acute? There are some predictable needs that people will have as they age. Instead of waiting for them to go to the hospital, why aren’t we upstream?”

Addressing those types of needs has become a priority at CMS, with primary care as a principal lever. The agency this year also unveiled the Making Care Primary (MC) model, which will launch in July 2024 in eight states — Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.

The agency intends for the 10-year demo to expand and enhance care management and care coordination. CMS plans to equip participating primary care clinicians with tools to form partnerships with specialists and to leverage community-based connections to address patients’ health and social needs.

This could include partnerships with hospice and palliative care clinicians.

“Palliative and hospice care are critical to a patient’s care journey. MCP participants will be required to form partnerships with clinicians of various specialty types, which will be referred to as Specialty Care Partners,” a CMS spokesperson told Hospice News in an email. “The final list of allowable specialty types for Specialty Care Partners will be released in the Request for Applications, but we anticipate that it will include hospice/palliative care.”

CMS is among the stakeholders recognizing a need for a more integrated, less siloed health care system, according to Matt Salmon, CEO of SALMON Health, a hospice, home health, palliative and senior living facility operator.

‘It’s changing this mentality that we were going to be somehow of value to the hospital system. We’ve really turned our focus away from what we can do in terms of adding value into that part of the health care system to looking at the value that we can provide for the residents that reside under our roofs,” Salmon said at Continuum. “With the advent of adding the home health, hospice and private duty company, we’re adding our skill and expertise to people living under their own roofs because people are starting to realize that it is worth it to pay for those services to stay at home.”


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