Providers of post-acute, home-based serious illness care know what works. They have been on the other side of the sheets with patients long enough to know that what is sometimes needed is not what is “prescribed” by the fee-for-service payment model, or by the CMS Hospice Benefit. They know that it may be a death doula who can walk the final steps with a family that is needed, or a community health worker who can solve the overwhelming practical issues that a family faces. They know that what will finally work to control pain may be acupuncture, or massage, or mindfulness training. However, none of those services are “covered” by traditional sources, leaving providers to either not offer these services or further struggle under already tight margins.
This is where value-based contracts and payment models can make a difference. Under such contracts, the providers are given a lump sum payment and allowed to design their care models within those resources as long as they create the results the payer is looking for which are tied to successful patient outcomes. They are given leeway to provide the services that are needed in each situation based on their clinical discretion. And those services can vary from family to family. Finally, the clinicians – who know their skills, resources, and patients best – are able to make broader care decisions, not the payers. While they still need to stay within the budget of those lump sum payments, providers are put back in charge of care.
Not only does this arrangement create more effective care models for patients, as well as higher satisfaction and productivity levels for staff, but it also creates market opportunities for agencies as a whole. Providing a diverse range of services can differentiate organizations within a market that will appeal to referral sources and consumers. It also creates the opportunity for collaborations and partnerships that will boost an agency within the healthcare continuum, perhaps opening the door for other networking prospects. This is the time to take advantage of value-based contracting for the sake of patients and families, your staff, and your agency.
“Death Doulas, Community Health Workers Collaborations can Aid Hospices, but Resources are Scarce” by Holly Vossel, posted by Hospice News on October 26, 2023 and accessible at https://hospicenews.com/2023/10/26/death-doulas-community-health-workers-collaborations-can-aid-hospices-but-resources-are-scarce