Studies have shown that providing hospice care earlier in the course of advanced, serious illness leads to better health outcomes, higher satisfaction, and lower care costs. However, when patients and physicians are forced to make the choice between hospice and curative care, hospice enrollment is often delayed.
The concurrent care model—also referred to as open access or simultaneous care—was developed to remove financial and psychological barriers to patients opting into hospice care. Under such models, patients do not need to choose hospice, palliative care, and curative treatments in isolation, and have a more gradual transition into hospice.
Here's why we see concurrent care as an emerging opportunity for population health managers.
Early evidence suggests quality a key benefit in concurrent care
Research reveals provider models using elements of curative and palliative care have successfully demonstrated improved quality and increased hospice referrals. Such models include home-based programs that ease the transition between curative and palliative care, and concurrent care offered by cancer and hospice providers.
By positioning concurrent care policies as part of a patient’s advanced care planning, physicians are more comfortable with in-depth discussions of end-of-life care options earlier in the care plan for patients with a terminal diagnosis. Hospice programs that have eliminated the need for patients to choose between curative and palliative treatments have seen a wide range of quality improvements for patients with advanced illnesses, including:
- Earlier referrals, earlier access to hospice, and fewer disparities in hospice utilization
- Improved collaborative relationships between hospice providers and referring physicians
- Fewer days in the intensive care unit
- Clinically meaningful improvements in reported quality of life and patient mood
- Increased patient and family engagement in discussing palliative options during advanced care planning
Longer hospice stays can result in lower total cost of care
Today, an estimated 29% of hospices have open access policies in place. Such providers tend to be nonprofit and cumulatively have an average daily census of 151 patients. In fact, some experts suggest that the minimum average daily census necessary to support an open access program is between 200 to 400 patients, which will enable hospice providers to effectively scale concurrent care resources.
Concurrent care programs can play a key role in value-based delivery systems. There are early indicators in both the Medicare and commercial populations that earlier enrollment in hospice (resulting from concurrent policy changes) decreases net medical costs for patients. This reduced spending is mostly attributed to fewer hospitalizations, re-hospitalizations, and emergency room visits for patients with these comprehensive hospice services.
Although early signs indicate benefits for hospice providers allowing concurrent care, two key financial challenges remain for the model:
- Concurrent care can potentially lead to an increase in overall hospice stays beyond Medicare’s hospice aggregate cap. For nonprofit providers where revenue is capped, increased utilization may not come with additional reimbursement after the threshold, resulting in increased hospice spending.
- Concurrent programs must serve patients with more complex care needs. When patients are discharged from the hospital earlier, they enroll in hospice programs with more advanced care needs. Hospice providers implementing concurrent care may need to invest in additional resources to manage more complex patients, which can increase the cost of hospice services without the promise of sufficient reimbursement.
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