innovation within the hospice benefit: diagnostic specific programming and other opportunities

1CareFirst

Innovation within the Hospice Benefit: Diagnostic Specific Programming and Other Opportunities

Robin Stawasz, LMSW Director of Provider Relations and Family Services

CareFirstCorning, NY

Hospital/Hospice Partnerships for Providing Inpatient Palliative Care

2CareFirst

Why change and why now?

• Call for change within the hospice industry • Changing healthcare environment

• Affordable Care Act • Medicaid reform • Medicare reform • Managed care • Heightened regulation

• Staying ahead of the curve


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• New opportunities to partner • Changing pressures on other providers

• Creating needs hospice can meet • Become the solution to other people’s problems • Efficiencies inherent in shared service • Examples from CareFirst’s LifeBeat Cardiac Hospice Program


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• New markets are available • Baby boomers increasing demand on healthcare

• More informed • Higher level of sophistication

• Drive for more home care • Increased provision of palliative care programs by hospices


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Why change and why now?Why change and why now?


• Survival • If we don’t do it, someone else will • Increased competition, even within certificate of need areas • Risk of marginalization, turning hospice

into a “boutique” service

6CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care

Why change and why now?Why change and why now?

• Mission • Become true advocates for palliative care

in all its forms • Traditional hospice is not the only way to

meet our mission • Not just an option, growth is what we are

called to do


Change must be planned and purposeful

• Based on need • Identify gaps within the care continuum • Perform empirical needs assessment • Meet needs of hospice • Meet needs of partner providers • Meet needs of families • Examples from CareFirst’s Breath Respiratory Hospice Program



• Create business plan • Perform comprehensive research

• Examine models and similar programs • Share between hospices • Determine best practices

• Outline how all stakeholder needs will be met



• Create a business plan• Define program structure

• Assign all responsibilities • Propose a pilot program with expansion only when appropriate • Address liabilities • Include plan for staff development and marketing



• Create a business plan• Create a budget for both finances and time • Join into formal contracts whenever needed • Examples from CareFirst’s Inpatient Palliative Care Program’s Business Plan • CareFirst’s Grief Services Development

Plan



• Build partnerships with fellow providers • Develop buy-in and investment of stakeholders • Identify mutual benefits and goals • Open opportunities for all involved • Hospices historically operate in silos • Examples from CareFirst’s Living with

Dementia Hospice Program


• Foster external change in how hospice is perceived

• Challenge preconceptions and assumptions • Change has to be real • Tremendous marketing opportunity • Specialized efforts for public and for providers

• Opening markets can create strong external advocates

• Examples from CareFirst’s Breath program



• Fostering internal change within hospice culture • Change within individual hospices

• Many are defensive of status quo • Our greatest strengths can often be our biggest obstacles • Comes through investment in process, education, commitment to mission • Must be solid prior to full launch of new programs • Examples from CareFirst’s LifeBeat program



• Fostering internal change within hospice culture • Shift within the hospice industry

• Consistent message and coordinated efforts will benefit all • Increase our influence on healthcare industry

in general • Increase use of benchmarking and sharing of

standard process outlines



• Diagnostic specific programs • LifeBeat • Breath • Living with Dementia • Mental Health outreach• Renal programming• Neurological programming

Opportunities for Change


• Managed care alliances • TBI/NHTD Waiver Alliance • Medical Homes • Accountable Care Organizations• Innovation grants



• Hospital partnerships • Inpatient hospice admissions • Inpatient Palliative Care programs • Disease management clinics • Boards and committees• Joint quality assurance and utilization review efforts




• Pediatrics • Perinatal programs • Medicaid waiver providers • Medicaid changes

• Pediatric provisions for concurrent treatment and 12 month

prognosis • Coming change to adult prognosis

standards?



• Marketing• Outreach campaigns• Example of CareFirst Re-branding efforts

• Other ideas?


Conclusions

• Program development within the hospice benefit is replicable, beneficial and critical

• True growth can only come through partnerships that benefit all stakeholders

• Internal and external change must be planned and purposeful and can lead to new growth opportunities

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Questions?

We encourage your questions and comments



CareFirst11751 East Corning Road, Corning NY 14830607.962.3100 or 800.734.1570www.CareFirstNY.org

Robin Stawasz, LMSWDirector of Provider Relations and Family [email protected], ext. 152

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innovation within the hospice benefit: diagnostic specific programming and other opportunities

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