60 seconds with ... Carol Raphael
Carol Raphael, AARP board chairwoman, senior advisor to Manatt Health Solutions
Q: You speak of how changing attitudes and demographics are creating “The New Aging.” What are some trends LTC providers should note?
A: There's been considerable change in palliative and end-of-life care planning. The percentage of Medicare beneficiaries who received hospice care in 2012 was 46%. In 2000, it was 23%. There's been a 157% increase in hospital-based palliative care programs.
Q: It's not just hospice, right? More providers are trying to cover the whole post-acute continuum.
A: System creation is creating ever-larger integrated delivery systems. A merger of Kindred and Gentiva this year expands Kindred's home health and hospice and creates the largest integrated post-acute care provider in the country. A joint venture of Envision and Ascension Health offers infusion, home care and hospice. It's very vital to realize that integration is happening horizontally as well as vertically.
Q: Can you explain what that means?
A: Integrated payment systems drive vertical consolidation, in which different types of providers join together. The desire to be the essential market provider, to reach critical mass, drives horizontal consolidation of a single type of provider. These are not mutually exclusive consolidation strategies.