The Evolving Palliative Care Market

According to the Center to Advance Palliative Care (CAPC), around 90 million Americans have some type of serious illness, and that number is expected to double in the next 20 years as our population continues to age. This will increase the demand for non-hospice palliative care, especially as current healthcare reform efforts move the locus of care into the community and out of facilities. The demand for PC is also increasing due to the high patient satisfaction levels with PC. This means that more consumers are looking for PC, more providers are comfortable referring to PC, and more payers are offering PC to build beneficiary satisfaction. In addition, PC’s ability to drive down costs through lower acute utilization and right-sizing care is making PC a powerful tool to those payers who are in risk-bearing, value-based contracts such as MA plans and ACOs. All of this is expected to fuel tremendous growth in the non-hospice PC field. 

Still, the lack of consistency within the PC field is both the biggest threat and the biggest opportunity for the future of PC. On the threat side, the lack of a universal definition of PC or a standard of care leaves the service open to interpretation. “Palliative care” can be interpreted as anything from information on advance directives to a fully staffed inpatient medical team and unit. This negates any attempts to build quality metrics, payment paradigms, research opportunities, and consumer expectations. On the opportunity side, the variety of services and providers allows for innovation, creativity, and collaboration that would be restricted by formal conditions of participation. Now is the time to take advantage of the flexibility offered to develop the standards that are most impactful and create the consistency that is needed. The one option that is not viable is not getting involved. Some post-acute care providers are choosing a “wait and see” approach to non-hospice PC, at least until a CMS PC benefit is created. Those providers stand a real risk of missing their place in the growing PC market as others establish themselves with strong PC programs partnered with dominant payer systems. CMS is using value-based payment models, such as ACOs, Medicare Advantage, Primary Care First, the Enhanced Oncology Model, and others, to build a non-hospice PC platform. That is where those who want to be a part of the growing PC field need to be. And the time to be there is now.

Source Material:

“The Forces Fueling the Palliative Care Market” by Holly Vossel posted on July 19, 2023, by Palliative Care News and accessible at https://hospicenews.com/2023/07/19/the-forces-fueling-the-palliative-care-market/