On June 29, 2023, C-TAC members, Empassion and Good Shepherd Community Care, led a discussion on opportunities for primary care at home and palliative providers to pivot from fee-for-service models and thrive in value-based arrangements, including CMS’s ACO REACH High Needs Model. The discussion was led by Terri Maxwell, PhD, RNA, Chief Clinical Officer, and Jenna Ackerman, Senior Director of Growth and Strategy, from Empassion Health; and Chelsea Shenker, the Director of Palliative Care from Good Shepherd Community.
Empassion is a dedicated managed services organization driven by a mission to support the delivery of value-based care models for patients with serious illness. With their commitment to improving patient outcomes, Empassion operates under full-risk contracts, enabling providers to mutually share risks based on their preferred level, while efficiently managing networks and implementing innovative program designs. The impact of these efforts translates into a comprehensive approach to care planning for patients, ensuring seamless integration across diverse care teams. Moreover, Empassion pioneers’ home-focused primary care, delivering innovative services such as 24/7 clinical call centers and urgent care visits. Empassion’s work revolves around one simple mission, “…to achieve more good days for seriously ill patients and their families,” according to Terri Maxwell.
By curating a highly coordinated network of healthcare providers, Empassion envisions a future where patients can break free from the cycle of hospitalization, returning home, and subsequent re-hospitalization. Empassion has experienced remarkable growth and currently stands as the largest value-based care network in the US that focuses specifically on addressing the needs of seriously ill patients.
Benefits of Value-Based Care
Jenna Ackerman led an in-depth conversation on the advantages of value-based care (VBC), which represents a transformative payment model that diverges from the traditional fee-for-service (FFS) approach. Unlike FFS, which reimburses healthcare providers for individual services rendered, VBC offers compensation based on the outcomes achieved for patients, emphasizing metrics like quality, equity, and cost-effectiveness of care. Within their community-based palliative care framework, Empassion wholeheartedly embraces these VBC principles, reaping numerous advantages over the conventional FFS model.
The community-based palliative care model adopted by Empassion yields significant benefits for both patients and providers alike. Patients, their families, and caregivers enjoy enhanced care experiences, while simultaneously witnessing improved outcomes at a reduced cost. Moreover, this approach enables a more streamlined coordination of care for complex patients, mitigating the challenges often associated with FFS models, such as limited billing capabilities and fragmented care. Empassion’s community-based model fosters an environment where patient-centric care thrives, empowering healthcare providers to deliver comprehensive and integrated support to those in need.
Innovative Partnerships
The Good Shepherd leadership was initially hesitant to collaborate on ACO REACH due to the failure of a previous model. However, as conversations started with Empassion, Good Shepherd made several key realizations. First, FFS has a limited future as a payment model in the healthcare industry, whereas VBC enables a more comprehensive approach to patient outcomes due to its ability to consider patients holistically, acknowledge their social determinants of health, and innovate creative approaches. Empassion’s platform also integrates a team drawing upon a plethora of diverse expertise, such as data analysis and business administration, into clinical care. “There’s this tremendous opportunity to serve patients and families,” said Chelsea Shenker, which encapsulates Good Shepherd’s perspective on the partnership. “And as a mission-based organization, that’s where we put our energy. That’s at the center of everything we do.”
The next issue to tackle was figuring out how to bring patients into the program. Originally, Good Shepherd relied on the approach of claims-based alignment, which depends on services billed to a patient in the previous two years. What they had found was despite there being a lot of patients with a slow, long-term decline in condition, many patients are either on a steep decline or have already died by the time claims were registered in the look back period.
Alternatively, the new path forward is by voluntary alignment, where beneficiaries who are existing patients or referred to Good Shepherd could learn and potentially align with ACO REACH.
In overcoming the barrier of finding the appropriate language to describe the program to patients and families, Good Shepherd found that people are generally very ecstatic about the opportunity to develop a deeper relationship with the organization. Especially for patients who can’t leave their homes to visit their care providers, it’s transformative to have a palliative care professional who can provide in-house care, assess the patient holistically, and communicate back to their long-term care providers. Ultimately, this synthesizing force proved to be incredibly meaningful.
Next Steps
Looking forward, Good Shepherd looks to build volume of their services. Ms. Shenker discussed the case of a non-compliant patient who the providers didn’t know couldn’t read or write and thereby couldn’t understand the pill bottle instructions. By spending time with them and getting to know them as a person, the in-house team was able to creatively translate and coordinate the proper care. Good Shepherd seeks to take into consideration all these other factors that don’t reveal themselves in a 15-minute visit to an outpatient clinic and address them using an expanded skillset.
Learn More About C-TAC’s Member Meetups and Membership
One of the benefits of a C-TAC membership is an invitation to participate in member-only events. Member meetups provide a valuable platform to receive updates on C-TAC member initiatives, highlight innovations, and engage in collaborative discussions. For more information on a C-TAC membership, please contact Luke Scuitto, C-TAC Partnership Director.
