Enclara Leaders Reflect on 2023 and the Road Ahead

After two tumultuous years in which hospice leaders faced a pandemic and widespread staffing challenges, 2023 has provided a welcome reprieve. Many hospices are reporting a return to growth, both in referrals and their ability to meet demand. However, this year has also brought new challenges.

Higher costs for labor and just about everything else have persisted. That has hospice leaders looking for savings anywhere they can find them. In addition to seeking efficiencies through improved workflows, hospices are taking a fresh look at their drug costs, which are typically their third biggest expenditure after labor and facilities. There are also big changes around quality measures. The much-anticipated CMS Final Rule has confirmed that The Hospice Special Focus Program (SFP) will move forward although leading national hospice organizations continue to express concern around implementation.

Enclara is continually working to help hospices adapt to the current business and regulatory environment and prepare for what lies ahead. In this year-end wrap-up, Enclara leaders share their observations, accomplishments and plans for the coming year. 

Mark Morse – Chief Executive Officer

I spend a lot of time interacting with hospice executives and one thing I have learned is that you need to ask the right questions. A lot of our clients have been with us for a long time and they aren’t always aware of everything we have to offer or the impact we can have on their operations. For example, nurse staffing remains a big challenge for many hospices, but the focus has shifted from recruitment to retention. Enclara is a big part of that. The experience we provide to nurses is a big part of their quality of life, professionally speaking. We also provide a wealth of educational programming to support nurse professional development.

The other side of that is starting conversations about new ways we might support our hospice partners. Hospice has traditionally been very siloed from the rest of healthcare, but that’s changing. As those lines start to blur, it presents opportunities and risk. What works in home care doesn’t always apply to home hospice, for example. The tools and expertise Enclara provides can help bridge those gaps, even as the medication access models differ.

Deanna Douglass, PharmD – Senior Vice President, Business Development

On the business development side, we tend to hear a lot about the pain points that are leading hospices to reconsider their pharmacy partnerships. One big issue this year has been local pharmacy access. With shorter hours and staff walkouts at retail locations, along with consolidation of closed-door pharmacies, hospices are looking for options. We are able to offer both strong local pharmacy locations and next-day shipping from our national fulfillment locations, which provides flexibility and peace of mind.

This year our implementation team supported the transition of a large, complex hospice organization to Enclara as well as several local and regional not-for-profit hospices. One thing I noticed is that as different as these organizations are, many of their challenges around staffing are similar. Our digital workflows and personal service help solve for that. If greater efficiency can help a nurse see one more patient per day or finish up on time for the day, that’s a win. We’re also seeing more inpatient beds coming online, both de novo and expansions. With smaller hospitals facing continued headwinds and reducing the scope of their operations, there is a lot of opportunity to leverage underutilized facilities to improve IPU access.

Megha Kadiyala – Senior Vice President, Product Management

We launched our new medication management application, E3 Pro™, in late 2022 and much of this year was continuing to refine the user experience and incorporate new functionality. Nurses are the primary users for this tool and they have been very engaged in providing feedback that helps us build our product roadmap. Nurses have also told us that they could benefit from more instruction and education for hospice caregivers about the medications the hospice prescribes. Today’s caregivers are increasingly comfortable utilizing technology, so we are in the pilot phase of an online caregiver offering with one of our hospice partners.

There is a lot of interest in leveraging artificial intelligence (AI) in hospice care. We are investing in predictive analytics to help hospices anticipate changing patient needs to improve care and reduce expenses associated with medication waste and rush orders. Internally, we are looking at ways to supercharge the knowledgebase that our contact center associates use when helping our hospice clients. When nurses call us, we want to give them the most useful information as quickly as possible so they can get back to patient care.

Anthony Dameika – Vice President, Marketing and Communications

The Enclara value proposition is multifaceted yet simply expressed by a single guiding principle: You deliver the care. We make it easier. This promise embodies our commitment to simplifying and enhancing every aspect of the hospice PBM experience. In 2023, we expanded our Voice of Customer initiative, reinforcing our commitment to shaping solutions that resonate with the real-world needs of our hospice partners, nurses, and patients.

Our efforts included establishing the Enclara Connected Care Community, a vital platform for hospice professionals to provide valuable feedback on Enclara products, resources, and tools. This platform allows us to collect qualitative feedback to complement the results of our annual nurse experience survey, which has shown consistent annual improvement in our overall satisfaction score in recent years. We also orchestrated collaborative sessions, bringing clients and Enclara leaders together to extract valuable insights and identify trends at a strategic, industry-wide level. Each of these initiatives helps inform Enclara’s overall strategy. One major area of interest is caregiver training and education, an area in which our clinical team is uniquely positioned to add value. Several departments are currently collaborating to expand upon our existing library of caregiver-focused content and develop new ways to disseminate this important information.

Ryan Krout, PharmD – Vice President, Clinical Management

Our analytics program is designed to help hospices deliver better care while managing costs, both of which are more important than ever with the shift to value-based care. This year we launched new proprietary utilization metrics focused on every stage of hospice enrollment. These metrics provide hospices with a clearer picture of their prescribing patterns to help identify areas of opportunity such as duplicate therapies and potential medication waste.

We are currently working on incorporating AI-driven predictive analytics, which will allow hospices to be even more proactive in meeting patient needs. With a better handle on likely disease progression, hospice teams will be able to be more proactive and reduce stress associated with emergent needs. There is potential there to improve the hospice experience for patients and caregivers, make life easier for clinicians and reduce costs associated with STAT deliveries.

Patrick Leary – Vice President, Client Services

We continue to see a lot of consolidation across the hospice sector. Acquisitions have slowed a bit, at least among smaller operations, but in the not-for-profit community there is growing interest in joining forces, either with a formal merger or in operational partnerships that enable these organizations to realize efficiencies while maintaining some level of independence.

Our account managers have noticed a higher level of engagement among our clients in terms of really leveraging everything we have to offer to help them achieve their business goals. Hospices are adjusting to the new normal of higher labor and operating costs. Pharmacy utilization and medication workflow efficiency are areas where we can really help and it’s gratifying to have the opportunity to do so.

Kerry Lord – Vice President, Information Technology

Today’s hospice leaders are more tech-savvy than ever and security is one of their top concerns. In years past, we would talk about our security certifications and they would just smile and nod. Now it has become a real selling point for us. Both new and existing clients are coming to us asking for an IT Security Agreement and supporting documentation, which demonstrates that they are taking this seriously.

Enclara’s IT team also does a lot of work behind the scenes to better support our hospice partners. For example, this year we were able to improve turnaround times for Conditions of Participation (CoPs) documentation by automating how that work was assigned in our contact center. In the coming year, much of our focus is on network resiliency. Hospices are 24/7 operations and they count on us to meet patient medication needs. We need to be prepared for anything, including extreme weather and cyberattacks.