Editor's note: This piece is an excerpt from our recently published report, 'The Future of Home Care: 9 Innovators Share Their Predictions for the Next Decade'.
The hospice care industry is on the brink of significant changes. As healthcare continues to move toward value-based care and increased accountability for patient outcomes, hospice providers must adapt to survive.
The Home Care Innovation Forum spoke with Susan Ponder-Stansel, CEO of Alivia Care, about how she sees hospice care transforming by the decade’s end. A few key themes emerged around leveraging technology to enhance care while reducing costs and improving patient outcomes.
“Hospice has not changed with the times the way some other types of healthcare have,” she said. “But we are in a moment where the tide is shifting. Changes are afoot and technology will be a major player in how hospice care is administered in the future.”
One of the most significant ways technology will improve hospice is through AI-powered patient stratification. As Ponder-Stansel explained, most hospices today take a one-size-fits-all approach, with nurses providing weekly visits regardless of each patient’s needs.
In the future, AI tools will enable providers to segment patients based on risk assessments. Those in a more stable condition may only need biweekly visits, while patients approaching the end of life or experiencing issues could receive daily visits. This level of customization will ensure patients get the right care at the right time.
AI will analyze real-time patient data from remote monitoring devices, electronic medical records, claims data, and more to flag changes that require interventions. Patients discharged from the hospital or undergoing treatment changes are examples of high-risk periods where more touchpoints may be warranted.
“Currently, there is a template where you're going to have a nurse visit every week, no matter what's going on with you,” she said. “So deploying AI tools will allow us to stratify our patients and pull up those needing extra visits.
“Some patients are going to get a visit every two weeks because they're stable, and others will get one every single day because the AI is telling us that they're at the end of their life or that their conditions are exacerbating so we can deliver more palliative services. AI will allow us to improve quality of care in ways we couldn’t have imagined five years ago.”
Another key application of technology will be remote patient monitoring through devices like wearables, in-home sensors, and telehealth software. These tools will allow hospices to keep closer tabs on patients between in-person visits.
As Ponder-Stansel noted, when patients are at home, their condition can change rapidly. Biometric data and two-way communication via telehealth visits enable earlier detection of issues like infections or medication reactions. Providers can then intervene quickly before the patient requires a costly ER visit or hospital admission.
Monitoring tech also facilitates better communication between patients, caregivers, and clinicians. Patients have an easy way to alert their care team to pressing needs.
Ponder-Stansel also believes that by 2030, we will see more tech-enabled companies manage seriously ill patients under full-risk arrangements rather than referring them to hospice.
“You will see those who can take on risk become bigger and work in a larger geographic area,” she said. “I think you will see those (providers) that can't do that and don't have any upstream services being moved much more to providing care in the very end of life.”
Hospices will also rely more heavily on seamless data exchange with other healthcare entities like hospitals and primary care physicians. Access to comprehensive medical records (EMRs) from across the care continuum is invaluable in crafting appropriate care plans.
Integrations with EMR systems will allow hospices visibility into emergency department visits and specialist appointments. This data paints a fuller picture of the patient's health status and trajectory.
Well-designed patient navigation platforms similarly centralize patient data from disparate sources for care coordinators. Such hospice CRM systems will help drive more informed clinical decision-making in the future, Ponder-Stansel said.
According to Ponder-Stansel, the hospice Medicare benefit structure has not meaningfully changed since its inception in 1983. However, CMS and Medicare Advantage plans increasingly scrutinize hospice spending and outcomes.
MA plans and other at-risk payers question the value of extended hospice stays, like 120+ days at $200/day, especially for diagnoses like dementia that involve minimal acute care utilization. Despite NORC research showing overall Medicare savings with hospice enrollment, payers want more accountability for outcomes.
CMS is concerned about hospice spending outside the per diem payment, such as medications and durable medical equipment. Requiring capitated payments or bundled rates can help alleviate this, but smaller hospices would likely find it challenging to take on full financial risk or manage capitated payments.
Ponder-Stansel said one potential model is bifurcating the payment system. Providers able to manage risk could elect capitation, while others would remain fee-for-service with reduced rates or utilization management. MA plans are increasingly managing seriously ill patients with their own or contracted palliative care services and only engaging hospice for very end-of-life care.
Hospice may migrate to just a final few weeks of “brink of death” care. Meanwhile, MA plans and serious illness management companies handle earlier palliative services under value-based arrangements.
Modernizing the hospice benefit could help by better accommodating caregiver needs, focusing on medical necessity over prognosis, and tying payment to quality metrics and cost outcomes. However, CMS currently prioritizes auditing hospices rather than updating the payment model.
“Medicare Advantage plans are expanding special needs plan options, so more patients who could have gone to hospice will stay in these provider networks,” she added.
As serious illness care models demonstrate outcomes, pressure will build to modernize the hospice benefit structure. More value-based purchasing and accountability measures will cause consolidation, with underperforming hospices closing.
“That is, unless providers adapt,” Ponder-Stansel said.
The remaining hospices will affiliate with larger systems and face higher standards. Overall, the increased availability of alternative models to enable serious illness care will disrupt traditional hospice care delivery, she said.
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