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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
Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
3CareFirst
Why change and why now?
• 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
Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
4CareFirst
Why change and why now?
• 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
Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
5CareFirst
Why change and why now?Why change and why now?
Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• 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
7CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
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
8CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Change must be planned and purposeful
• 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
9CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Change must be planned and purposeful
• 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
10CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Change must be planned and purposeful
• 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
11CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Change must be planned and purposeful
• 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
12CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• 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
Change must be planned and purposeful
13CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• 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
Change must be planned and purposeful
14CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• 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
Change must be planned and purposeful
15CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• Diagnostic specific programs • LifeBeat • Breath • Living with Dementia • Mental Health outreach• Renal programming• Neurological programming
Opportunities for Change
16CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• Managed care alliances • TBI/NHTD Waiver Alliance • Medical Homes • Accountable Care Organizations• Innovation grants
Opportunities for Change
17CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
• Hospital partnerships • Inpatient hospice admissions • Inpatient Palliative Care programs • Disease management clinics • Boards and committees• Joint quality assurance and utilization review efforts
Opportunities for Change
18CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Opportunities for Change
• Pediatrics • Perinatal programs • Medicaid waiver providers • Medicaid changes
• Pediatric provisions for concurrent treatment and 12 month
prognosis • Coming change to adult prognosis
standards?
19CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
Opportunities for Change
• Marketing• Outreach campaigns• Example of CareFirst Re-branding efforts
• Other ideas?
20CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
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
21CareFirst
Questions?
We encourage your questions and comments
Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
22CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care
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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