Community-Based Palliative Care Benefit Could Shake Up the Home Health Market

Today, in-home care providers that offer palliative care services typically do so as a way to win referrals and bridge gaps between home health and hospice.

Launching palliative care service lines is a strategic decision focused more on patient care than reimbursement opportunities, considering there’s still no fully baked community-based benefit in fee-for-service Medicare. But that could soon change, industry leaders believe.

“We’re incredibly hopeful that this is the year, after decades of talking about it, that we’re actually going to get a benefit that we can wrap our arms around,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization (NHPCO), said during a keynote address at his organization’s annual leadership conference.


According to Banach, there’s growing momentum for a community-based palliative care benefit because the COVID-19 pandemic highlighted a need for high-touch, comprehensive care for seriously ill individuals.

On top of that, career U.S. Centers for Medicare & Medicaid Services (CMS) leaders transitioning into the Biden administration have also expressed a solid understanding of the need for palliative care.

As a former deputy director of the agency’s Medicare-Medicaid Coordination Office, that’s something Banach has clear insight into.


“We’re still in the thick of COVID-19, which is a serious illness, with it comes the need for interdisciplinary care,” Banach told Hospice News, a Home Health Care News sister publication. “The crowd that’s coming into CMS and [the Center for Medicare & Medicaid Innovation] are folks who know what we’re talking about and are receptive to what we’re talking about. I’m not making any guarantees, but we’ve also received really good feedback.”

Potentially, a full-fledge community-based palliative program could be based on the Medicare Care Choices Model (MCCM) demonstration, Banach noted. Broadly, the model allows participants to provide routine home care and at-home respite care while enrollees are also pursuing curative treatments.

MCCM has caught the attention of health care policymakers, as it has reduced Medicare costs by $26 million during its first four years, CMS previously reported. The demonstration was established in 2016 and is scheduled to end in June 2021.

“Also helpful is the sense that a community-based palliative care demo would be built on the chassis of a successful demo, which is the Medicare Care Choices Model,” Banach told Hospice News. “The evaluation seems to be showing cost savings and improvements in quality.”

Several home health players have already invested heavily in palliative care — or have plans to.

In the California market, San Diego-based Mission Healthcare began testing out the palliative care waters in the summer of 2020 through a relatively targeted pilot. In 2021, it has since expanded its palliative focus across its footprint, which includes 14 offices across the Golden State.

“We found that there was an unmet need,” Mission CEO Paul VerHoeve previously told HHCN. “A group of patients were kind of falling in between the cracks, going home with a lot of needs but not necessarily being able to be supported or followed accordingly.”

Amedisys — which simultaneously ranks as one of the largest home health providers in the country and one of the biggest hospice organizations — has likewise signaled its interest in palliative care. 

“I want to get us to the point where each patient can get a personal care person, a home health person, a palliative care person or a hospice person exactly when they need them,” Chairman and CEO Paul Kusserow told HHCN in July 2020.

While the isn’t a formal palliative care benefit in fee-for-service Medicare, it is something that an increasing number of Medicare Advantage (MA) plans have added to the mix.

An analysis by the consulting firm ATI Advisory found that the number of health plans offering home-based palliative care coverage jumped to 134 in 2021, up from 61 in 2020.

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