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Florida-based nonprofit Alivia Care is focused on gearing up for value-based systems in 2024.
Alivia Care came into existence in 2020 when Community Hospice & Palliative Care, now an affiliate, formed a larger company with a wider range of services. The organization has since expanded into Georgia and established itself in the home health and PACE arenas with plans for further expansion.
Susan Ponder-Stansel, CEO of Alivia Care, sat down with Hospice News and its sister site Home Health Care News at the HomeCare 100 conference in Scottsdale, Arizona, to discuss the ways providers need to retool in order to care for the burgeoning seriously ill, senior population.
What are your biggest 2024 focuses, challenges and goals?
We’re really focusing on value-based care, which is that piece of primary care where you have the alignment, and you’re able to manage that risk. And with hospice, it’s a good way to get a pipeline soon.
We are working with the at-risk physicians in the [Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model] to figure out how to be a partner, so those folks get the care that they need. Our system isn’t really set up for that now. But that’s what we’ve been doing for all these years, so we’re really looking at that as a big opportunity.
We’re also at risk already with our PACE program. So we really believe that that’s going to be the way that you succeed financially and be able to deliver better outcomes to seriously ill patients, including those at the end of life.
When you’re in any kind of value-based situation, you do need all the private duty, the Medicare certified hospice, adult daycare and PACE and primary care as well.
That seems to be common among a lot of providers that do have the capabilities that we’re talking about is value-based care. You really need to layer those services on top of each other.
Unlike hospice, I’ll take PACE, for example. It’s a longitudinal service. Many mature programs have had their participants with them for 10 or 15 years, and you’re managing them to keep them in the community out of the hospital. Now, they may go into long term care intermittently after a hospitalization, but they’re not custodial. They’re not living there. And you have many different tools to do that.
The challenge is that there’s so much consolidation in so many big companies with a lot of [private equity] investment, or a nonprofit regional, so you’re always weighing and balancing how fast you can get your solution going into the market without having to merge or something like that. It’s a serious question. You always have to weigh that opportunity versus cost. But so far, we haven’t had to go that route.
But with the costs of some of the things that are coming with home health, and just the cost of labor, a lot of us are seeing margin compression. So we’re really looking at understanding that our typical Medicare fee-for-service business is probably not going to get us where we want to go.
On the other side of that coin, there’s typically as I understand that lower reimbursement in value-based models as well. As you pursue those kinds of relationships, how do you offset that or prepare for that?
It depends on which value-based program, because there’s so many flavors of that, too. So like with PACE, for example, Florida’s Medicaid rates are terrible. That’s why we haven’t had much competition for PACE down there. But these are dual eligibles, so for most of these, you’re looking at their [hierarchical condition category (HCC)] scores.
For almost all of these centers, you’re getting your monthly payment, your per-member per-month, based on their acuity, and then it’s up to you to manage it. In New York, that might look like $1,600 a month per PACE participant per month.
But that’s the point I like about Special Needs Plans (SNPs), you get that book and the money and you really get to make decisions based on the patient’s needs without going back for pre-authorization. But the thing is you’re upside and downside risk, and you really have to have some good AI. Because you need to understand your population and make sure that you’re meeting that need.
You really have to understand those risk factors, and then really see what your costs are and be able to manage those. And that includes all the things you have to provide, like the pharmacy and the specialty services. All that we learned, we learned the hard way on PACE.
You’re basically a health plan at that point. You’re completely responsible, and you have to create the entire network. It is really the best way to provide care to people with chronic illness. But you need a certain size and scale. You’re always looking at whether you are the right size, are there partners you can work with, like other hospices.
It seems like his movement towards these at-risk relationships is necessary to survive in today’s environment. Are you excited about that opportunity or are you more worried about it?
Both, I really believe that we can get the funds and then do good patient-centered care and help people who have these serious illnesses have better outcomes. To me, that’s the carrot. You’ll make some margin if you do it well. But honestly, if you can create that person-centered care based on your knowledge as to what serious illness care should look like and build a better system, I think that’s important.
