1 CareFirst Innovation within the Hospice Benefit: Diagnostic Specific Programming and Other Opportunities Robin Stawasz, LMSW Director of Provider Relations and Family Services CareFirst Corning, NY Hospital/Hospice Partnerships for Providing Inpatient Palliative Care

2 CareFirst 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

3 CareFirst 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

4 CareFirst 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

5 CareFirst 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

6 CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care 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

7 CareFirst 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

8 CareFirst 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

9 CareFirst 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

10 CareFirst 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

11 CareFirst 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

12 CareFirst 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

13 CareFirst 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

14 CareFirst 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

15 CareFirst 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

16 CareFirst 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

17 CareFirst 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

18 CareFirst 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?

19 CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care Opportunities for Change Marketing Outreach campaigns Example of CareFirst Re-branding efforts Other ideas?

20 CareFirst 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

21 CareFirst Questions? We encourage your questions and comments Hospital/Hospice Partnerships for Providing Inpatient Palliative Care

22 CareFirst Hospital/Hospice Partnerships for Providing Inpatient Palliative Care CareFirst East Corning Road, Corning NY or Robin Stawasz, LMSW Director of Provider Relations and Family Services , ext. 152 Contact Us