Contessa Sees Home-Based Palliative Care as ‘Linchpin’ of Business

Contessa Health’s leaders see palliative care as the true linchpin of their business and have plans to grow the segment in the near future.

Though Amedisys Inc. (Nasdaq: AMED) purchased Contessa last year, it has allowed the company to operate independently, which has enabled Contessa leaders to maintain focus on their own growth trajectory, particularly in palliative care.

At Hospice News’ recent Palliative Care Conference in Chicago, Contessa COO Aaron Stein said that he and Amedisys Chairman Paul Kusserow are “extremely bullish” on palliative care overall.


“The feeling we get when we talk to clinicians — especially in hospice and home health care — is this sense that there’s a lot of patients that fall through the cracks because there’s not that longitudinal model that’s in place,” Stein said. “I think our palliative care segment is going to become much more significant at Contessa. We, like everybody else, think that palliative care is an underused service.”

Based in Nashville, Tennessee, Contessa Health is one of the pioneers of at-home, high-acuity care delivery. Its partners include Penn State Health, Mount Sinai Health System, Henry Ford Health System, Marshfield Clinic Health System, Ascension Saint Thomas, CommonSpirit Health and Highmark Health, among others.

Amedisys acquired the company last June for a purchase price of $250 million.


On its end, the Baton Rouge, Louisiana-based Amedisys is one of the largest home health providers in the U.S. It also provides personal care and hospice services, delivering care to nearly 500,000 patients per year through over 500 care centers in 39 states and the District of Columbia.

Today, Contessa’s palliative care segment reaches 13 states, and Stein said he would imagine that’s going to continue to grow as it moves forward, particularly in value-based arrangements.

Stein said Contessa defines palliative care as life-enhancing care provided to patients with serious illness. The company believes palliative care needs to not only be medical-focused, but also social-focused.

“Sometimes it’s social determinants and other times it’s simple things like relationships, religion and other things that really need to come together for patients at the end of life,” he said. “This care model is there [to make sure] patients are not left seeing 30 doctors in their last year of life.”

Contessa’s joint venture process

In addition to palliative care, finding the right partners is one of the key growth levers for Contessa.

When considering joint ventures, Stein said the company looks at several factors.

“We’re looking at the types of payers that tend to dominate the admissions that go into the hospital,” he said. “We also look at the types of admissions, the types of patients, the practices they may have and their fortitude for change — including being in value-based arrangements.”

When striking a deal with a joint venture, Contessa will come up with a three-year business plan that is highly variable, according to Stein.

“Some of it varies because there’s different tolerance by health plans for the types of innovation that we’re talking about,” he said.

Contessa uses a projection model for the first three years of a joint venture and will consider anything from payer to hospital when determining goals for the launch.

Stein said he’s encouraged that hospitals are investing in palliative care. He also pointed out the bright spot that is Medicare Advantage in the space.

“If Medicare Advantage ultimately ends up seeing a lot of patients in these types of programs, our belief has been that ultimately fee for service eventually will follow along,” he said. “With the increased penetration these days of Medicare Advantage, for me, it’s natural to think that that would happen.”

In order for home-based palliative care access to improve in the U.S., Stein believes it comes down to two things: scale and reimbursement.

On the reimbursement side, a palliative care at-home benefit would help companies like Contessa offer that kind of care to more patients.

“And in terms of scale, you just can’t afford to have people driving around in their cars all day, there’s too much downtime in order to make that happen,” he said. “As a guy that was growing this company that was free-standing for a few years, that’s what really excites me about the Amedisys marriage, because now we’ve got the scale. We’ve got the amount of patients that need to go through it and it’s a matter of really expanding this and proving to the government that we can do it.”

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