For home health companies, embracing palliative care can improve their overall service offering. However, healthcare providers often stop short before establishing programs to improve patient outcomes.
Although home health-run palliative care is rare, companies like Visiting Nurse Health System, Contessa Health, and Compassas have successfully incorporated these services into their broader care delivery models.
There are several common pitfalls that home health providers should avoid when building an effective palliative care services program.
“One of the biggest challenges is positioning palliative care as early hospice,” Nikki Davis, Contessa's senior vice president of palliative care programs, said at Home Health Care News' FUTURE conference. “And make sure you have clear eligibility and referral pathways. Then when you partner with home health teams and hospice teams, you can have those processes in place so it's very clear who is eligible for palliative care.”
Contessa provides comprehensive home care. The company is based in Nashville, Tennessee and works with 12 health systems and 30 health plans. Amedisys Inc. (NASDAQ: AMED) acquired Contessa in 2021.
Dr. Kurt Merkerz, Nikki Davis
Amedisys offers a Medicare Part B-based palliative care program, and Contessa also offers a values-based palliative care program.
“Within Contessa's value-based space, we have several different financial agreements and different levers to pull for how they work,” Nikki Davis said. “One of the things that's unique is our joint venture, where we actually partner with health systems to provide different types of home-based services: home hospital, home-based SNF, home-based palliative care. We also have direct contracts with insurance companies to help care for members who need palliative care at home.”
Providers also have full risk agreements with payers. Nikki Davis said the company plans to monitor and decide which approaches to future growth merit further investment.
Dr. Kurt Merkerz, Chief Medical Director at Compassus, outlined a number of reasons why home health care providers can derail from implementing effective palliative care programs.
“We're not really investing in the value that palliative care brings, so we're not offering a comprehensive, multidisciplinary, complete palliative care package,” he said. “This is one of the biggest hurdles and roadblocks that comes from not properly planning and strategizing what the components of palliative care are going to look like. The next thing you think about is a structure that is too focused on just the RN or just the LPN model. True palliative care is a true multidisciplinary approach. You need the full range of support services to really achieve the patient outcomes that you need.”
Based in Brentwood, Tennessee, Compassus provides a wide range of home care services, including home health, home infusion, palliative care, hospice care, and home critical care. We have over 270 touchpoints in 30 states. Compassus' palliative care program is operated through a joint venture. The provider recently expanded its joint venture with Providence Health System, with a focus on strengthening home care services.
Breaking down silos, coordinating care
Another common mistake home health providers make when implementing palliative care programs is creating unnecessary silos.
“We think about clinical integration with home health agencies,” Merkerz said. “We cannot maintain palliative care service lines as silos; doing so will continue to propagate what is common in a fragmented medical field.”
Merkerz says a lack of understanding of the demands of palliative care programs can also undermine their success.
“Starting too small and not recognizing how quickly the palliative care referral system can overwhelm the system can lead to potential service failures and staffing issues,” he said. “It takes months to start onboarding and certify physicians through various insurance agencies to get them through the process and have enough (staff) to provide care.”
dorothy davis
Dorothy Davis, president and CEO of Visiting Nurse Health System, emphasized the importance of engaging with the company's home health staff to increase understanding of palliative care.
“To me, it's no different than recognizing whether someone is a good fit for hospice or is a better fit for hospice than home health care,” she says. “What's the right setting at the right time to provide the best and greatest value for patients and caregivers? I think our workforce in general, and from an industry-wide perspective, our workforce is not very well-educated.”
Atlanta-based Visiting Nurse Health System provides a variety of home care services to more than 7,000 patients throughout Atlanta. The company's palliative care program has been in place for 15 years. The company's current model operates under Medicare Part B.
Ultimately, Dorothy Davis believes that coordinated care is a key element in implementing an effective palliative care program.
“Transactional care is not life-changing in the same way as coordinated care,” she said. This is the perspective we take to palliative care in the visiting health care system, recognizing that we need good processes and good entry points. ”
