Hospice Growth Strategies in a Value Based Payment System

What is happening in Home Care and Value Based Payment (HHVBP) is predicted to arrive on Hospices’ doorstep over the next few years. As we march through 2022, there are 15 Medicare Advantage Organizations comprising 115 insurance plans in 22 states participating in the CMS demonstration project. The final model is still undefined, and the question remains what the final VBID will look like and is your organization ready for change.

Hospice Growth Strategies in a Value Based Payment System

The challenge for hospices is how to prepare?  Obviously, you don’t want to be way out ahead of the curve not knowing the final model.  And at the same time, “Hope Is Not A Strategy” and responsible leaders need to prepare and anticipate change.

The questions we receive from hospices deal with how best to start preparing and developing growth related strategies in this new payer environment. This article will outline a number of growth strategies that make sense to pursue in a VBID environment.   The first step, however, is to understand what the new payment model most likely will value and be based on and how to strengthen your position in these key areas.

Developing a Culture of Growth that embraces the elements in the Value Formula below in my opinion will build a strategic framework to help your hospice prepare for change.

Value = Outcomes + Experiences/Cost

What is new in this formula is the emphasis on experiences.  Family experiences drive their level of satisfaction and willingness to recommend a hospice.  This provides an opportunity from a business development/marketing standpoint to have a positive impact. Achieving a 5-Star Rating becomes significant. VBID is being designed to improve quality and timely access to goal-concordant care (providing hospice care that honors a patient’s goals and values) and eliminates fragmentation. Several studies have shown a strong direct correlation between satisfaction and patient/family compliance to care plans.  Thus, high satisfaction levels will lead to better outcomes.

The specific outcome measures used in the model are still being refined.  There is collective thinking that the VBID model will have a transformative impact on end-of-life care which will drive hospices to focus on reaching patients sooner to improve outcomes.   The new payment model (no matter what final model looks like) will be designed to get “more upstream” of the traditional eligibility for hospice. The reasons some hospices are rushing to develop palliative care programs.

Delivering efficient cost-effective care will be more paramount than ever.  Honing your care model and organization to be “lean and mean” is essential. For not-for-profit hospices, bifurcating your cost between core care delivery items and other programs and services that relate to activities outside the core business, i.e., community-based bereavement, chronic disease management, etc. will be important to demonstrate a good cost position.  Learning how to value and honor your mission and charitable work while strengthening your business acumen will be a skill set worth developing!

Where to start!  We suggest your organization go through what ever planning process you have in place to take stake in your organization’s readiness. The strategies below are suggested as a framework to that planning process and supports growth in a value-based payment environment   Growth becomes much more than just a sales and community outreach function.

Strategy #1:  The Power of Differentiation.

More than ever, being able to differentiate your hospice on clinical, programmatic, partnership and professional elements will be key for growth. Both for the reasons of standing out from other hospices and developing programs/services that support better outcomes and patient/family engagement. Understanding your unique position in the marketplace will better prepare you for participating and being viewed as an asset to Medicare Advantage Organizations and others.

Some examples for consideration.  A clinical differentiator could be developing a concurrent care program to care for more complex patients. Concurrent care will make you a much more attractive partner to insurance companies as well as hospitals.   Another, for those hospices that have a home care associated with them, the development of an oncology specialty program would allow for the management of cancer patients and drive better clinical outcomes.

A professional differentiator could be a Physician Advisory Board (PAB). A PAB is a group of 12 or so community physicians that agree to be members of the PAB which meet 3 times per year.  This strategy is an excellent tool to better engage community physicians and obtain their input and ideas on services and programs that can enhance your position in a VBID environment.

Your planning process will assist you identify other unique differentiators.

Strategy #2:  Strengthen your Technology

Strengthening your technology for the purpose of gathering, analyzing and reporting outcomes and cost data will be vital.  Now is the time to evaluate and make needed improvements.

Here are three examples of how technology can be used as an accelerator in a Value Based payment environment.

  1. Accurate, timely data will be critical in a VBID environment. Assess your ability to easily gather and report outcome and data. How are your current data gathering and reporting efforts coming with HCI, CAHPS, etc.? How well is your EMR talking to your CRM?
  2. The ability to conduct remote monitoring will also be an important tool to support clinical outcomes and deliver cost effective care. Some of the benefits of remote monitoring include, improved data driven clinical decision making, helping patients with self-management and patient/family compliance to care plan. Remote monitoring has also demonstrated a reduction in patient care expenses, building patient engagement and proving a boost to net revenue.
  3. Technology can also be used to improve communication which is a key element to improving the overall patient/family experience. I have learned that if you don’t give families information, they make it up.  And it usually doesn’t work in your favor.  There is a communication app that provides real time communication between family members, hospice staff and other professional involved in the patient’s care.  Please do feel free to reach out to me and learn more.

Strategy #3: Improving Your Referral Inquiry to Admission Process:  Reimagining Access

Ease of use and access for any company is an important pillar for growth and satisfaction.  In hospice, there are five fundamental elements required for a superior Access Center.

  • Being able to assure you are capturing ALL your referral inquiries. Not hoping that you are capturing them, but knowing you are.
  • First-to-bed-side wins. A strong sense of urgency! Building the capacity to respond in-person to all your inquiries with within 24-hours.  Creating a team of “first-responders” who can meet a family and say “you’re not alone anymore” establishes a foundation for trust, positive communication and high levels of satisfaction.
  • Eligibility Process. Having a “bullet-proof” eligibility process is critical. Eliminating single points of failure by having an eligibility team or committee in place will assist here.  Eligibility training and education for your physicians and nurses so they are on the same page is a staple of this process.
  • Building and Working a Superior 90-Day Pending List. For ALL your referral inquiries that do not admit within 24-hours place them on a pending list which identifies the barriers to why they did not admit. Then over the next 90-days work to eliminate those barriers.
  • Organizational Wisdom. Building a culture where everyone in your organization can assist eliminate barriers and leave no patient behind.

The first 24-hours when a patient/family reaches out to your hospice is critical to establishing satisfaction.

Strategy #4: Building a Professional Sales Model.

VBID will require sales staff to be true hospice consultants.  Hospice sales associates will need to have clinical knowledge that will lead them to more informed sales calls.  The Days of Muffin Marketing are over. A professional sales team built on a keen knowledge of hospice, clinical savviness and understanding how hospice will work in a value-based model will be “table stakes” for success in serving more people and growing.

Building a knowledgeable sale team that understands how to sell on value to key referral segments will be an important pillar to support growth.  Each referral segment, i.e., hospitals, senior living communities, personal care home health agencies, etc. have a unique value proposition regarding their use of hospice. Sale professionals must be able to distinguish and clearly understand how to deliver value to a variety of referral sources.

Invest in the skill set development, training and hospice knowledge development for your sales professionals as much as you do for your clinical staff!!

Strategy #5:  Palliative Care Programming.

Palliative Care is considered a clinical differentiator and a stand-alone strategy. The current challenge with Palliative Care is a stable reimbursement source. While efforts are under way to improve reimbursement, no solution is yet in place.

There are numerous hospice based Palliative Care models in place across the country.  Here are three examples, Hospital inpatient palliative care consultation, community-based programming or what is referred to as “bridge program.”  These are a few examples with many variations on these models in existence.

Most hospices who have started a Palliative Care Program did so as a strategy to begin dialogue sooner with patients and families to transition them to hospice more smoothly. Some of these programs however became run-way trains in that they turned into Chronic Disease management program.

Palliative care programs that are well defined, have a strict set of criteria for admission and can demonstrate a 60-70% conversation rate from palliative to admissions can realize success. In a VBID environment, having a well-defined palliative program can be an asset.

Strategy #6: Formalize Your Partnerships

Build and strengthen your relationships with insurers, hospitals, and other hospices in your community. Try your best to understand what your insurers are experiencing.  Share your outcome data as a method to start a dialogue.  What potential needs or gaps can you fill.  Seek opportunities to formalize a relationship with them.

Approach the hospitals you do work in and share with the C-Suite your data on the referrals you received from them and how long these patients lived.  I’m sure your data will show a portion of these patients died before they were admitted or within a day or two.  I have used this strategy many times and I can assure you the C-Suite people will have some epiphanies.   This will lead to dialogue that can assist structure a better a relationship.

Approaching other hospices in your community to develop alliances can be beneficial.  This strategy particularly applies to not-for-profit hospices. Meet with your fellow not-for-profit hospices and seek aways in which to partner.  This strategy will make the group much more attractive in a value-based payment model.  A few examples of this are the California Hospice Network and four not-for profits hospices that collaborated in Florida called the Synthase Collaborative.

So Where To Go From Here

Remember, Hope is NOT a Strategy.  Change is coming in one form or the other.  Stay abreast of what is evolving with VBID.  Communicate with your State and National Associations to both obtain current news and ask the question, “What Does This Mean For My Hospice?” Set up Google Alerts for Hospice Value Based Payment, Hospice Medicare Advancement to stay on top of breaking updates.

We suggest going through whatever strategic planning process you have in your organization as a good place to start.  Taking stock in the six strategies sighted here to determine how you can improve will serve you well no matter what the final VBID model looks like.

Determine the best methods to enhance your patient and family experience will take on more importance in a VBID environment. There are several strategies mentioned here that are easy to work on. Investing in customer service training.  Starting with your Access/Admission staff. Remember, the 5-Star Rating System will carry much more weight.

Once your strategies are in place, execute, execute and execute some more!

Kurt A. Kazanowski MS RN CHE
Managing Partner
Hospice Advisors
296 S. Main Street, Ste. 202
Plymouth, MI 48170