Alivia Care CEO: Success in Palliative Care Depends on Strong Program Design

Hospices are working hard to develop new business areas such as palliative care to reach patients earlier and capitalize on value-based care opportunities. As beneficial as these services can be for both patients and providers, the importance of effective program design cannot be overstated.

Florida-based Alivia Care is part of a growing group of palliative care providers who have pursued new opportunities to expand their continuum of care, including palliative care, home health and other services. Amid these initiatives, the organization is facing brutal industry-wide headwinds – with labor shortages topping the list.

Since its inception, Alivia Care has focused on growth. The nonprofit emerged in 2020 when Community Hospice & Palliative Care of Florida rebranded itself into a larger company with a wider range of services. Since then, the launch of new programs and the pursuit of affiliations have become priorities.

Alivia President and CEO, Susan Ponder-Stansel, of Alivia Care, recently spoke with Hospice News about strategies for service diversification and referral growth at a time when staff are scarce. .

Many palliative care providers have turned to palliative care services, including Alivia Care. What are some of the most important factors driving this trend?

Palliative care programs recognize that they need to go upstream to improve both overall palliative care utilization and timely access to palliative care. Falling lengths of stay have been a tail end of the pandemic, so reaching patients before the last days of their lives is critical.

Many of us have developed palliative care programs or transitional care programs to help fill the void in our highly fragmented care system that leaves patients without a clear roadmap between acute or curative care and care. palliatives.

What are the common pitfalls encountered by providers when creating a palliative care program from scratch? How can suppliers avoid them?

Among the pitfalls I have seen is the poor design of the palliative care program so that it ends up being a place where patients stay too long. Getting the design right for palliative care to provide the right amount and type of support, but not ‘hospice lite’ is a challenge. Many hospices actually develop their own “surrogate competition” without realizing it.

The second problem I often see is approaching palliative care with the perception that it is a profit center rather than a cost center.

With current reimbursement, most of us rely either on Medicare Part B payment for medical services or on a contracted rate from a health plan or other payer, which rarely covers the full cost of the service. Understanding that palliative care is part of care navigation and transition services, as opposed to something that will be cost-effective on its own, is important from the start.

Finally, many hospices are developing this service without looking at who is already in this space in their market, and without being able to identify and explain the unique value proposition of their particular flavor of service offerings. Many competitors in this space use telephone or virtual support models to deliver service, which gives them cost advantages when negotiating with payers. Most palliative care programs I’ve seen use “boots in the field” to deliver this care, but I don’t have the data to prove that this leads to better outcomes than virtual programs that many companies private offer.

As for work pressures, has the tension eased or improved recently?

Staffing constraints have not eased and show no sign of doing so. Difficulty finding and hiring clinicians at all levels, including doctors, has been a constant source of stress for hospices.

We continue to see workers make the decision to leave the workforce or change jobs so they can work fewer hours or have a better work-life balance. This will continue for years to come and represents a demographic shift, not a temporary trend.

Staffing shortages have continued to weigh financially this year on hospices. How do you see workforce pressures impacting results in 2022?

Workforce pressures will be the toughest drag on the bottom line that hospice palliative care programs will face – not just in 2022, but for many years to come. For many providers, understaffing has forced them to close beds in palliative care units, be unable to care for patients, or provide services such as ongoing home care.

Supply not meeting demand is driving up the costs of the labor portion of our business, not only in direct clinical care, but in some other critical support areas such as IT and accounting. .

The other complicating factor is the exit of traditional baby boomers and the older Gen X workforce, as well as the different view of compensation, work-life balance and the role of work that younger Gen Ys and older Gen Z staff will have. Many of us are ill-prepared to deal with this demographic shift in the composition of our workforce.

Many hospices have had to invest more in technology to gain efficiency, expand telehealth services and stay competitive. What are some of the most pressing financial issues for hospices when it comes to technology?

Technology will allow us to alleviate many of the challenges we will face in the years to come, including our staffing shortages. Ensuring our clinical documentation wastes as little staff time as possible will be key to recruitment and retention, as will using technology to improve processes and offload things that can be done by someone else. other than our licensed professionals.

Technology will also be needed to improve patient care and enable hospices to avoid emergency room admissions or care crises.

Additionally, technology will be required for the level and quality of data that each of us will need to support our decisions and assess our outcomes, both for our internal use and for payers and regulators.

If the [U.S. Centers for Medicare & Medicaid Services (CMS)] continues to allow telemedicine and telehealth visits to be reimbursed, there will be both strong consumer acceptance of receiving this method of care and willingness from hospices to use this tool for patient care appropriately and useful.

Cost will be a challenge for small palliative care programs. Navigating the complexity of all new and emerging technical products is a real concern for many.

Investments in new technologies can be costly, and we can’t afford to be wrong. But sifting through all the noise to assess what will truly meet our needs will require different skills and knowledge than many vendors currently have access to in-house.

Where is the needle in terms of growth opportunities for palliative care in the years to come? Which care settings could offer the most promising referral flows?

Residences for the elderly and residences for retirees will be part of the opportunities of the future. Baby boomers and their families definitely want to age in place and be cared for rather than having to go to a care facility.

Hospice is a unique, person-centred type of care that fits well with the desires of those who want to remain independent for as long as possible.

And, if concurrent palliative or transitional care becomes a payment under regular health insurance, patients with end-stage dementia, kidney and neurological disorders may be willing and able to come to palliative care in much greater many more than is currently the case.

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