A true value-based provider living in a payer world


By Gwen Cooper

The recent American’s Health Insurance Plans (AHIP) conference in San Diego was full of insights and opinions. In our ever-changing healthcare system, providers must understand the mindset of payers to stay ahead of the new value-based care curve. I came away with the validation that hospice providers have had it right from the beginning.

We are value based, person centered care personified. Enacted in 1983, the Medicare hospice benefit was the first capitated (value-based) payment model embraced by Medicare, paying providers a single rate to provide complete, integrated, multi-disciplinary care for patients until the end of their lives.

When payers discussed how they are working to build a system designed to meet patient’s needs, I thought, “Helllooo, it’s already created, just tap into the proven method of patient care and imagine how many lives we could improve and imagine how much money we can save the system.”

It’s right under the nose of literally every payer in the country are nonprofit hospice and palliative care providers whose mission has always been to wrap our value-based services and complete interdisciplinary teams around patients and families to provide the most compassionate person-centered care until their very last breath.

And now, we continue to wrap our services around patients and families but upstream from hospice care. Many hospice providers have begun to roll-out their own innovative models of advanced illness care upstream from the hospice palliative care programs as part of their service menu and in partnership with local hospital systems and payers that see the value in providing person centered care to the most seriously ill. Advanced illness care/palliative care is shown to reduce hospital readmission rates and frequent ER visits for disease symptom management.

While hospice is not a substitute for advanced illness care, these programs can feed into a quality hospice program that provides compassionate care at the end-of-life. By providing the same model of care to patients with an advanced illness while they continue treatment, we are better able to manage their pain and progression of their illness much earlier.

While we know that providing hospice care is not about giving up but about compassionate pain and symptom management, respite care, grief counseling, spiritual care and so much more, we also know that introducing the same care approach much earlier in one’s chronic illness journey will have lasting quality outcomes for both the patient and their family, not to mention also lowering healthcare costs.

It was nice to see that the payer industry is beginning to embrace our model of person centered care. A broader understanding of the benefits of interdisciplinary medicine as early as possible to help manage a chronic illness is the healthcare game changer that we’ve been practicing for 40 years. I am hopeful that organizations like ours will have a seat at the table with payers nationwide ready to engage hospice providers in the design of this new payment model.

-Gwen Cooper is the senior vice president of marketing and business development and chief external affairs officer at Hosparus Health.


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