CEO Jonathon Fluhart cut his teeth in the hospice and serious illness space working on the operations side of companies like Intrepid USA and Heritage Home Health & Hospice. He launched the palliative care startup PalliCare earlier this year with nurse practitioner and chief operations officer Tiffany Hughes. The founders shared the goal of improving community-based access to those services, beginning in the company’s home state of Texas.
PalliCare has a two-fold approach within its care and business models. The company directly employs nurse practitioners and licensed clinical social workers who provide direct care, most often in nursing homes. In addition, PalliCare also serves as an incubator that supports nurse practitioners in setting up their own practices.
“We’ve created a culture for nurse practitioners. We ask them what they want to achieve as a nurse practitioner,” Fluhart told Hospice News. “Every one that we talked to said they had a passion for working with patients in their home as an RN, and they wanted to do more in providing that care.”
PalliCare has developed a “hub and spoke” approach to care delivery and growth, according to Fluhart.
The company manages the electronic medical records system, human resources functions, insurance considerations and licensing and credentialing, among other business services. Without having to attend to these back-office considerations, the nurse practitioners are able to devote their time and resources to building their clinical practices, Fluhart told Hospice News. This model is also designed to foster work-life balance for clinicians.
“Home-based care has turned into a grinder for nurses. We are trying to establish them in communities where they don’t have to travel long distances, create their own schedules, work in two or three nursing homes and see as many patients as they feel able,” Fluhart said.
Fluhart began his career in the aerospace and technology fields, often managing implementation of Lean Six Sigma quality improvement methodologies. His early work in health care concentrated on hospice and home health, and at the time palliative care was not on his radar.
That changed after he met Hughes, who is now chief operations officer for PalliCare. The two kept in touch after meeting at a conference, and Hughes continued to inform Fluhart on the benefits and the need for the palliative care model. This in time led them to collaborate on building a new palliative care company.
PalliCare received its Medicare certification in late September, and their initial recruitment push showed promise. More than 50 applications came in during the first day.
PalliCare is launching at a time when more avenues for reimbursement for its services could be opening up.
Currently, the U.S. Centers for Medicare & Medicaid Services (CMS) covers palliative care physician and nurse practitioner services, but the model does not include the full range of interdisciplinary care. CMS in 2020 also began allowing Medicare Advantage plans to cover palliative care as a supplemental benefit.
Establishing a dedicated Medicare benefit has been a mounting priority for providers and industry groups, as well as some lawmakers.
In July, the four founding members of the Senate Comprehensive Care Caucus introduced the Expanding Access to Palliative Care for Seniors Act. If enacted, the bipartisan bill would push the Center for Medicaid & Medicare Innovation (CMMI) forward in the process to roll out a community-based palliative care demonstration.
The closest existing equivalent to a palliative care benefit is the U.S. Centers for Medicare & Medicaid Services’ (CMS) test of the Medicare Care Choices Model (MCCM), which allows hospice patients to receive curative care concurrently with hospice. The agency recently announced that it was extending the program by one year. The test was originally scheduled to close at the end of 2020.
A new CMMI demonstration would likely contain elements pioneered through the MCCM.
“A lot of work is being done trying to set up a way to provide palliative care and get it paid for,” Hughes said. “We decided the best thing for us to do is to build a standalone community-based platform that gives us the opportunity to customize our relationships to best meet the needs of our referral partners and tailor our care to the needs of their patients.”
Providers nationwide have seen a rise in demand for palliative care during the COVID-19 pandemic. More patients and families are also seeking serious illness care in their homes — a trend that began in earnest long before COVID-19 hit, but the pace has accelerated.
In addition to the benefits for patients and families, home-based palliative care could reduce societal health care costs by $103 billion nationwide within two decades, the nonprofit economic research group Florida TaxWatch reported in 2019.
A major obstacle for palliative care growth is the general lack of awareness of these services among the public as well as clinicians in other disciplines. A study earlier this year found that close to 90% of people in the United States have little to no understanding of palliative care.
Education and building trust were important first steps in founding PalliCare, according to Hughes.
“We’ve seen this happen where a company will come into a community without sitting down with health care leaders, and they just start seeing patients,” Hughes told Hospice News. “We spent the first several months meeting with stakeholders in the community to help them truly understand what palliative is. Once they understand it, they get very excited, because there are so many patients who need this care.”
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