NHPCO Q&A with Dr. Madison
Transitioning to Value-Based Care: The Rise of Hospice and Palliative Care
Q: What is the current state of end-of-life planning in the United States?
A: Unfortunately, end-of-life planning is often overlooked and underutilized in the current healthcare system. Studies show that only 3% of patients nationwide engage in high-quality, robust advance care planning (ACP) conversations, while 10-30% of Americans have some form of ACP. This lack of planning leads to poor end-of-life experiences, unnecessary care, and excessive costs, with $250 billion in annual Medicare expenditures occurring in the last 12 months of life.
Q: How is the transition from fee-for-service to value-based care impacting end-of-life care?
A: The shift towards value-based care models is creating new opportunities for hospice and palliative care departments. In a fee-for-service model, providers often lack the time and reimbursement to have in-depth conversations about advance care planning with patients. This results in late enrollment in hospice and palliative care, limiting the benefits these services can provide.
However, in value-based care models, the focus is on improving quality outcomes and reducing total costs of care. By involving hospice and palliative care earlier in the care continuum, providers can have meaningful discussions about patients' goals and preferences, leading to better end-of-life experiences and lower costs.
Q: How can hospice and palliative care departments position themselves to thrive in a value-based care environment?
A: To succeed in value-based contracts, hospice and palliative care departments need to establish their rightful seat at the table alongside the healthcare system's value-based care leadership. This involves:
- Presenting the hospice and palliative care program as a cost-effective mechanism to reduce the total cost of care and improve quality outcomes.
- Collaborating with population health managers to identify high-risk patients who would benefit most from early palliative care interventions.
- Tracking metrics such as advance care planning completion rates, quality measures, and end-of-life costs to demonstrate the value of their services.
- Ensuring robust reimbursement models that incentivize early engagement, advance care planning, and improved quality of care.
By taking these steps, hospice and palliative care departments can transition from being perceived as cost centers to becoming integral partners in delivering high-value, patient-centered care.
Q: What are the key benefits of this transition for patients and healthcare systems?
A: When hospice and palliative care departments are empowered to engage with patients earlier in the care continuum, several important benefits can be realized:
- Improved patient and family experience at the end of life, with care aligned to their goals and preferences.
- Better quality outcomes as measured by the Quintuple Aim (patient experience, population health, cost, workforce well-being, health equity).
- Reduced total cost of care, especially in the last months of life, by avoiding unnecessary hospitalizations and interventions.
- Greater leverage for hospice and palliative care departments to drive change and promote health equity within the healthcare system.
By embracing their role in value-based care, hospice and palliative care teams can transform the end-of-life experience for patients and their loved ones while also delivering significant value to the healthcare system.
Dr. Madison will be presenting this topic at NHPCO's Annual Leadership Conference in Denver, CO.