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Aspire Health: Aspirational Care for the Seriously Ill

Andrew Bouldin

Rolling Hills Ventures's portfolio company Aspire Health was recently featured in Nashville Medical News. 

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On July 1, Aspire Health — the company envisioned by Sen. Bill Frist, MD, and co-founder Brad Smith to provide an extra layer of support to those facing serious illness — made its debut in Nashville.

The palliative medicine company, noted Frist, has the potential to revolutionize advanced illness care in the United States … much the way hospice did for terminally ill patients nearly 40 years ago. Launched in Nashville, the plan is to create outpatient palliative care clinics and a physician network across the nation to better manage symptoms associated with life-threatening illness and chronic disease to improve outcomes and decrease costs associated with hospitalizations and Emergency Room visits. As Frist noted on the corporate website, “Advanced illness management is one of the few areas in healthcare where patients, caregivers, physicians, and health plan’s incentives are well aligned.”

To oversee clinical operations, Aspire recruited Andrew Lasher, MD, as chief medical officer. Lasher, who is board certified in both internal medicine and hospice and palliative medicine, relocated to Nashville from San Francisco. Prior to his new role at Aspire, Lasher was director of palliative medicine for California Pacific Medical Center and regional director for the specialty for the hospital’s parent organization, Sutter Health.

The decision to relocate with his family was an easy one. Lasher noted, “There are very few things in medicine that help people live longer, feel better and at a lower cost. This job allowed me to spread the gospel.”

Typically, he continued, palliative care has happened in the hospice setting or in a limited, home-based setting. He was intrigued by the idea of taking that highly personalized care and replicating it on a national scale.

“The idea is we will start in Nashville, take wonderful care of vulnerable patients in this community, learn what works and what doesn’t — in terms of physician outreach, in terms of quality of care provided, in terms of measurement — and then partner with other providers in other communities to build a network of palliative care practices,” he said.

Lasher continued, “The primary focus of palliative care is to relieve pain and suffering. We help patients live as long as they can, as well as they can.” Unfortunately, he continued, “For patients with an advanced, serious illness, there is very little out there until close to the end of life.” Unlike hospice, he pointed out palliative care allows physicians and nurse practitioners to meet the patient wherever they are in their journey … including working with those still actively seeking curative or experimental treatments for their disease or illness.

The need to expand palliative medicine, Lasher continued, is great. A major void exists in outpatient care for the seriously ill who are not yet ready for hospice services. Typically, palliative medicine serves three major patient populations: 1) those who need symptom management but are not eligible for the hospice benefit as defined by a diagnosis of ‘six months terminal,’ 2) those who have life-threatening conditions who are still seeking aggressive therapies to address the root illness, and 3) those who are hospice appropriate based on their diagnosis but are not philosophically or emotionally ready.

“People live with cancer and heart disease or after stroke for years after the diagnosis or event. They need a lot more care over the last chapter of their life … no matter how long,” Lasher said. “Right now there is no system to care for them outside of a hospital setting,” he added, noting the much higher costs associated with inpatient care.

Despite the cost effectiveness and evidence-based improved outcomes associated with such care, reimbursement remains a tricky proposition. By documenting and demonstrating those outcomes, Aspire hopes to help drive the conversation regarding a federal payer mechanism. “We all believe Medicare recognizes the value of palliative care and will ultimately find a way to pay for that care,” he said. In the meantime, reimbursement for many patients is made under the fee-for-service system, which doesn’t fully cover the care dispensed.

“But we’re working very closely with payers who recognize the value of what we do in terms of quality of care to identify more creative ways to reimburse for our services,” Lasher said. He added that MissionPoint has stepped up with a contract that more fully recognizes the depth and breadth of services provided under the palliative umbrella. Lasher said a number of other payers are also looking at similar incentives around value-based medicine.

Many patients seen by Aspire ultimately qualify for the hospice benefit so the plan is to help patients make that transition at the appropriate time. In Nashville, the palliative practice was launched as a joint venture with Alive Hospice to form Aspire Health Medical Partners of Middle Tennessee. However, Lasher stressed that patients are free to select any hospice provider they choose when … or if … the time becomes right.

For Alive Hospice, partnering with Aspire made perfect sense to strengthen the continuum of care. John L. Shuster, MD, chief medical officer for Alive, noted, “This partnership really was attractive, and it’s exciting. I’ve been doing this for a long time … hospice and palliative care are really all one piece … and they ought to be.”

He also sees a great kinship between the founders of Aspire and those who launched Alive in 1974 … a full decade before the hospice Medicare benefit came into play.

“The pioneers at Alive were willing to step up and meet the need and start from scratch and test new models even when there wasn’t a funding mechanism,” he pointed out.

Shuster, who is double board certified in psychiatry and in hospice and palliative medicine, said the Medicare benefit was both the “best thing and worst thing for hospice care.” At issue is the definition of terminal illness embedded in the legislation. “The intention was really, really good and solid, and this has done much, much, much more good than harm,” he stressed of the 1984 provision.

However, he continued, “I think the six month eligibility criteria for hospice created this gap … this chasm … between acute care and hospice care.” Shuster added, “Americans don’t want to choose between quality of life vs. quantity of life.”

The beauty of palliative care, he continued, is that it takes so many of the positive elements of hospice care and makes it available to people who fall in the gap.

“What’s exciting about this partnership is I think it really honors the spirit and the vision of the founders of this institution. Guess where we are with palliative care? We’re exactly where we were with hospice care when Alive Hospice was founded,” he pointed out.

Shuster continued, “We’ve been looking for a way to contribute to the field of palliative care the same way we did for hospice 38 years ago.”

He is confident that together Aspire and Alive will fill the gap in care to bring comfort to patients, improve symptom management, and increase a patient’s quality of life while ultimately lowering costs to the system.

By: CINDY SANDERS of Nashville Meidcal News Posted: Monday, September 9, 2013 8:15 am