Wall Street Journal: ‘Death-Predicting’ Company Expands At-Home Palliative Care

Aspire Health, a high-profile startup recently featured in the Wall Street Journal, continues to make a name for itself with an in-home palliative care model driven by a “death-predicting algorithm.”

Co-founded by CEO Brad Smith and former Senate Majority Leader Bill Frist, Nashville-based Aspire in October secured $32 million in funding from GV, the firm formerly known as Google Ventures. So, it’s safe to say investors see a bright future in the Aspire model. This model is based on that “death-predicting algorithm,” to use the WSJ’s language, which flags patients at risk of dying within a year. Aspire’s caregivers then can provide interventions for these patients in their homes to keep their quality of life high and their costs of care low, such as by preventing unneeded hospitalizations.

Currently, the company contracts with health systems, such as Medicare Advantage or Medicaid managed care plans. These entities typically pay a flat monthly fee to Aspire, calculating that the cost savings and improved patient outcomes are worth the price. Aspire estimates it can save these health plans $8,000 to $12,000 per patient, the WSJ reported. Aspire is operating in 19 states, managing care for more than 20,000 Medicare Advantage patients.


About 5% to 10% of those patients also receive care from a home health agency (HHA), Smith tells Home Health Care News. Sometimes an HHA will refer a patient to Aspire, if the patient is enrolled in one of the participating health plans and could benefit from palliative care services. Sometimes, Aspire will suggest bringing in the home health provider to supplement its palliative care services.

“Typically, if it’s medical in nature or an overarching type of care, that’s something we’re typically providing,” Smith says. “If it’s a routine process—wound care is most common example—it’s something the home health agency [would provide].”

Some concerns have arisen regarding the Aspire approach, including that its life-expectancy projections are based on data from people’s medical records, such as their diagnoses or hospitalization history.


“Medical ethicist Arthur Caplan of New York University says that ‘a private entity snooping around’ in patient records and consulting their doctors without prior consent seems like a violation of privacy,” WSJ reporter Melinda Beck wrote. “Aspire says that working with health plans to coordinate patient care is an approved use of such data under Medicare rules.”

Aspire’s payments often are tied to certain quality metrics, including patient and family satisfaction, Smith emphasizes. This helps ensure that care remains patient-centered, focused around their own goals, and is not driven too purely by cost containment motives.

Overall, the Aspire approach is trying to fill what Smith sees as a significant need in the health care space. And he’s not alone. There is a “huge gap between hospitals and hospice,” Diane E. Meier, director of the Center to Advance Palliative Care at the Icahn School of Medicine at New York’s Mount Sinai Health System, told the Wall Street Journal.

Prominent voices in home health also have spoken out on this topic. Increasing palliative care is a “critical issue,” Visiting Nurse Associations of America (VNAA) President and CEO Tracey Moorhead told Home Health Care News last year.

Written by Tim Mullaney

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