Dresang, CEO of YoloCares: Focus on quality palliative care, financial health will follow
Change is in the air for YoloCares, based in Davis, Calif., formerly Yolo Hospice, the nonprofit organization has completed a rebrand to reflect its growing range of services while launching a new day program for adults.
The program is housed in a new adult day center, Galileo Place, following a $1.6 million renovation on the existing Yolo campus.
Last fall, Yolo also joined the California Hospice Network, a collaboration of nonprofit hospices seeking to leverage their collective scale and resources in value-based payment programs and expand the ‘Health care access.
Hospice News sat down with YoloCares CEO Craig Dresang to discuss the provider’s trajectory and its outlook for the hospice and palliative care space.
First, I wanted to ask you about your rebranding. Can you tell me about the impetus for change and the message for patients and families?
The brand change was a very long time in coming for us. The first problem we have been thinking about for several years is that the word “hospice” is a barrier to accessing care. Our whole philosophy in our agency revolves around breaking down barriers to care. It is also an important element of equity in health care. We have decided to remove the “H-word” from our name.
We were the first organization in Northern California to be accredited by the Joint Commission in community hospice care, and our hospice program has grown quite rapidly. In fact, it outnumbered our palliative care program for a while. Then we realized that the word ‘hospice’ wasn’t entirely descriptive of what we do either.
Three years ago we had another non-profit merger with our organization called Citizens Who Care. Historically, their mission has been to support the frail elderly, and they have done so through a number of programs.
One was a volunteer program, where volunteers would go to someone’s home and provide respite. It was not respite in the medical sense. It is in this sense that there would be a professionally trained volunteer to go and be with your loved one if the caregiver had to be away for shopping or other things they needed to do.
It was an additional program that fitted into the organization, and they had a vision, as we have had for many years, of creating an adult day program. Coming together gave us the opportunity to do that, because we had shared donor pools and a very strong synergy between our missions. By coming together, we were able to make a non-profit adult day program a reality.
That was really the impetus for this to happen.
You just mentioned Citizens Who Care. Can you add some color to this organization and how the integration has improved your business?
One of the reasons we were so interested in merging this organization with us was because the work they do is so focused on the caregiver and caregiver support. We thought this was an opportunity to merge into our own palliative care program an organization that has a decades-old history as professional home caregiver support.
It really makes our program stronger than any other palliative care program. I have never seen an organization so committed to supporting caregivers and integrating it into the palliative approach.
What led you to give priority to support for carers?
I have been a caregiver in my life. My history of interest in palliative care dates back 25 years, when I was the caregiver to my mother and my first partner who were both dying of terminal cancer. Living this experience, both with and without hospice – and knowing the price it cost me – is a challenge.
There is a lot of research that has been done that shows that caregiver death and suicide rates go up after the loss of a loved one, especially if they have been sick for a while.
Our caregiver support is so in line with the philosophy of hospice, because care is for the patient and the family. It is all unity. We must support family and friends in this work if we are to succeed. So it was only natural for us to think about Citizens Who Care being part of what we do.
YoloCares recently opened the Galileo Place adult day facility. Can you give details about the center and the work you do there?
This is a new line of business at our current campus in Davis [Calif.]. We spent approximately $1.6 million to renovate the north end of our building and convert a rear parking lot that adjoins the building into a therapeutic garden.
For the adult day program, we were unable to open due to COVID and trying to keep our community safe. But we have a soft opening at the end of this month, and there is light at the end of the tunnel. We hope to be fully operational by summer.
It’s a 10,000 square foot facility unlike any other day program in our market. Careful attention has been paid to every detail, from the furniture and artwork on the walls, to the floor plan, to the amount of light that enters the installation.
The floor plan even creates a sense of travel for attendees so those with perhaps a bit more advanced dementia can have a sense of exploration as they walk around the facility and move around. inside out and back inside.
Can you elaborate on some of the community needs the center is there to meet?
We have an advisory board of professionals and community leaders who worked to envision what an adult day program should look like here. This committee met regularly for two years to really create the vision for this facility.
The Caregiver Commitment is one of the programs that is going to make this really unique. We have a teaching lab built into the facility that will be used by caregivers to come and sign up for classes and learn how to change a dressing, maybe adjust the position or help a loved one out of their bed.
We will be running a regular slate of courses for Community Caregivers. They will be free. We actually secured funds from a number of sources to pay for this. There’s a lot of support right now for caregiver programs, and it’s really helping us get the program off the ground in a way that we otherwise wouldn’t have been able to.
Could you elaborate on how linking an adult day service with a hospice benefits your organization from a business perspective?
The decision to have an adult day program here was much more of a mission decision than a business decision. We had to make sure it made financial sense, so we could afford to do it. We have developed the structure to support financially.
For our palliative care and adult day programs, in addition to fee-for-service contracts, we also get support from hospital systems for this work and physicians in our communities often refer patients to these programs. They see the value and the systems respond in kind with financial support.
This goes directly to my next question. You have invested a lot of effort in developing your palliative care program. Can you add some color around the types of payment arrangements you’ve developed to support it?
We have contracts with payers like Partnership Health and Blue Shield. In addition to this, Dignity Health and Sutter Health also supported the palliative care program.
Our goal is quality. We believe that if quality comes first, your finances will take care of themselves. This is a fundamental principle that we sometimes lose sight of in health care. It has proven true here, and it has proven true in my 20 years of work in hospice and hospice care.
Every time you lose sight of this mission and your commitment to quality, you will start to struggle financially.
Everyone has heard this phrase: No margin, no mission. I heard that a lot around the dinner table growing up. My favorite aunt was a Franciscan nun who was a community hospital administrator. This idea that we need to operate with business acumen was ingrained in me with my own family members as I grew up in the industry.
If you have that commitment to the mission and focus on quality, that financial element will take care of itself. I see it playing out over and over again.
I would like to know your point of view on the long-term prospects for palliative care. There has been a lot of discussion and advocacy about creating a dedicated payment model within Medicare. How could a program like this change the game?
Reimbursements for palliative care are just shy of $300 per day per patient. For palliative care, this is the average reimbursement in our market. This allows you to have a registered palliative care nurse, a health care aide who comes to your house as often as you need them, a CNA, a social worker and a chaplain if you need them.
We pay for all medications related to your diagnosis, all [durable medical equipment] all covered for around $300 a day. If you imagine that the provision of palliative care has somehow turned into a provision of palliative care, the reimbursements could be similar or even lower than they are for palliative care services. Instead of looking at a six month prognosis, you could have an 18 month prognosis.
You would see nationally the quality of care, patient satisfaction, people’s sense of well-being increase, and it would save our health care system billions of dollars. But there must be a will at the national level to do so.
Aside from the possibility of such a benefit, what else do you see on the horizon in the palliative care space?
I think more and more insurance payers are seriously considering palliative care from their perspective, because of the cost savings.
It’s much better to care for someone where they want to receive that care and to build a relationship of trust with their care provider. When we can spend time with patients, we can have more of a people strategy in how we approach their care, looking at mind, body, and spirit.
I think the case for expanding palliative care and integrating it into the national health care system is definitely there. I think it’s just going to take time.