Carve-In or Carve-Out? The Future of Hospice Under Medicare Advantage | Part Two

In Part Two of Future-Proofing Care: The Challenges We Face in Hospice and Palliative Care, Chris Comeaux and Cordt Kassner explore the accelerating forces reshaping hospice and palliative care—from shifting patient demographics to the rapid rise of AI and regulatory complexity. As the industry transitions to serving a more diverse, resource-variable baby boomer population, leaders are challenged to rethink how care is delivered, personalized, and sustained in an increasingly complex environment.  The conversation dives into the tension between innovation and regulation, the transformative (yet imperfect) role of technology, and the growing mental health crisis impacting patients, families, and care teams alike.  With AI poised to revolutionize communication and care delivery—but infrastructure and human connection still critical—the episode emphasizes a central truth: technology must enhance, not replace, the heart of care.  Ultimately, this episode offers a strategic roadmap for leaders navigating uncertainty.  Through the memorable framework “Grow, No, Flow, Sow, R&D,” the hosts provide actionable insight into building resilient, future-ready organizations—equipping healthcare and nonprofit leaders to move from feeling overwhelmed by change to actively shaping what comes next.  Key TakeawaysDemographic shifts—especially the rise of the baby boomer population—are redefining care expectations, financial realities, and caregiver availability.  Innovation is outpacing regulation, creating friction—but also opportunity for leaders to proactively shape policy.  AI and emerging technologies will dramatically transform care delivery, but must be used to enhance—not replace—human connection.  The mental health crisis is increasingly intersecting with hospice and palliative care, exposing systemic gaps and new responsibilities.  Organizational culture (“reculture”) is the critical enabler—or barrier—to successfully navigating rapid change.Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics Host:Chris Comeaux, President / CEO of Teleios, Author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part One of this forward-looking series, Chris Comeaux unpacks the foundational challenges shaping the future of hospice and palliative care. Drawing from nearly a decade of strategic research and collaboration with healthcare leaders, he introduces a powerful framework built around eight core challenges that every organization must navigate.  From intensifying competition to shifting reimbursement models, this conversation equips leaders with a clearer lens to anticipate disruption and respond with intention.What emerges is not just a list of problems—but a strategic roadmap.  Chris explores how “hypercompetition” is reshaping referral patterns, how financial pressures demand organizational agility, and why workforce shortages require a complete rethinking of care delivery.  Throughout the episode, the emphasis remains on proactive leadership: understanding the forces at play, asking better questions, and positioning organizations to thrive—not just survive—in a rapidly evolving landscape.Ultimately, this episode serves as a call for healthcare leaders, nonprofit executives, and hospice professionals to rethink traditional models.  By embracing innovation, diversifying services, and aligning care with what patients truly want, organizations can future-proof their mission and remain deeply relevant in the years ahead.  Key TakeawaysThe future of hospice and palliative care is shaped by eight major challenges, including competition, reimbursement, workforce, and demographic shifts.  Hypercompetition is accelerating, including both direct competitors and “substitution” models that can divert referrals.  Reimbursement pressures are expected to tighten, requiring organizations to become more efficient while exploring new revenue models.  Workforce shortages are a structural reality, demanding an “outside-in” approach that aligns staffing with evolving patient needs.  Long-term success depends on organizational ambidexterity—the ability to optimize current operations while innovating new care models simultaneously.  If you’re leading in hospice, healthcare, or the nonprofit space, this conversation is just the beginning.  Subscribe to the podcast, in Part Two, where we go deeper into solutions and strategies you can apply immediately. Share this episode with your leadership team, and start the conversation: Are we truly prepared for what’s ahead?Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics Host:Chris Comeaux, President / CEO of Teleios, Author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part Two of this thought-provoking conversation, Chris Comeaux and Robin Heffernan unpack the complex realities shaping the future of hospice under Medicare Advantage. From the lessons learned in the VBID demonstration to the growing momentum behind “carve-in” models, this episode explores the tension between cost, quality, and patient experience—and what it will take to align all three.  At the center of the discussion is a critical question: how do we design a system that truly rewards high-quality care while eliminating inefficiencies and poor outcomes?The conversation dives into emerging models like concurrent care “bridge pathways,” which challenge the traditional binary transition into hospice and offer a more patient-centered approach to serious illness care. It also tackles the impact of private equity, consolidation, and payer incentives—raising important considerations about accountability, network design, and the sustainability of mission-driven providers.  For leaders navigating an evolving healthcare landscape, this episode provides both clarity and challenge on what comes next.  Key TakeawaysThe VBID demonstration revealed both promise and limitations—strong outcomes are possible, but only with better network control and quality alignment.  “Concurrent care bridges” may offer a more realistic and compassionate transition into hospice, improving patient experience and outcomes.  Financial incentives must shift toward total cost of care, not fragmented payment models, to truly drive better patient outcomes.  Consolidation is likely, but high-quality providers—regardless of size—can still thrive if value and outcomes are prioritized.  Payer accountability and earlier palliative care engagement are key to reducing costs while improving care quality.  Guest:Robin Heffernan, PhD, Co-Founder and CEO, EmpassionHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy Of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part One of this thought-provoking conversation, Chris Comeaux and Robin Heffernan explore the evolving intersection of private equity, artificial intelligence, and end-of-life care—raising critical questions about accountability, quality, and the future of hospice under Medicare Advantage. As the healthcare system shifts toward value-based models, the discussion challenges long-held assumptions about whether hospice should remain “carved out” or be fully integrated into payer responsibility.Robin offers a systems-level perspective, arguing that aligning financial accountability across the entire patient journey—including end-of-life care—could drive better outcomes, reduce fragmentation, and elevate hospice quality. At the same time, Chris voices the concerns shared by many hospice leaders: issues of trust, the deeply human nature of end-of-life decisions, and the risk of reducing care to cost-containment mechanisms.Together, they unpack the real tension facing healthcare leaders today—how to preserve the holistic, compassionate ethos of hospice while navigating economic realities, emerging AI capabilities, and increasing private equity influence. This episode invites listeners to think critically about what must change—and what must be protected—as the future of serious illness care takes shape.  Key TakeawaysAlignment drives accountability: Integrating hospice into Medicare Advantage could incentivize payers to prioritize quality outcomes across the full continuum of care—not just upstream services.Quality vs. access tension: Without strong network design, “carve-in” models risk perpetuating low-quality providers rather than elevating high-performing hospice organizations.The economics are shifting: Value-based and capitated models may ultimately reward high-quality hospice providers more than traditional fee-for-service structures.AI will expand early intervention: Predictive analytics and lower-cost engagement tools could identify patients earlier and broaden access to palliative care conversations.Trust remains the central challenge: End-of-life care is fundamentally different—patients and families must trust that decisions are guided by care, not cost.If this conversation challenged your thinking, don’t stop here. Share this episode with a colleague, reflect on how these shifts impact your organization, and join the dialogue shaping the future of end-of-life care. Be sure to subscribe so you don’t miss upcoming episodes that continue to explore leadership, innovation, and purpose in healthcare.Guest: Robin Heffernan, PhD, Co-Founder and CEO, Empassion Host:Chris Comeaux, President / CEO of TELEIOS, Author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part Two of this forward-looking conversation, Dr. Jean Kutner explores how a landmark $64 million NIH grant is poised to reshape the future of palliative care across the lifespan. Moving beyond theory, this episode dives into what success actually looks like—more diverse research collaboration, stronger mentorship pipelines, and measurable translation of evidence into real-world clinical practice.  The discussion highlights a critical shift: building a system where research and care continuously inform one another to improve outcomes for patients with serious illness.Looking ahead, Dr. Kutner paints a compelling vision of a more seamless, equitable care continuum—one that begins earlier in the disease trajectory and extends across all stages of life.  From addressing gaps between care settings to advancing innovative modalities and policy-relevant research, this conversation underscores the urgency of aligning evidence, reimbursement models, and care delivery.  For healthcare leaders and hospice professionals, this episode offers both a strategic lens and a hopeful outlook on where the field is heading.  ⸻Key TakeawaysThe future of palliative care depends on expanding research capacity across disciplines, including underrepresented fields like chaplaincy and social work.  Stronger collaboration between researchers, clinicians, and policymakers is essential to translating evidence into practice and policy change.  A major goal is creating a seamless care continuum—eliminating gaps between hospice, inpatient, and outpatient palliative care settings.  Evidence-based care must drive reimbursement and policy models, including potential payment structures for pre-hospice care.  The field is moving toward earlier, more personalized palliative care interventions across the full lifespan, supported by emerging research and innovation.  Guest:Dr. Jean Kutner, Distinguished Professor of Medicine, University of Colorado Anschutz, Chief Academic Officer, UCHealth and Contact Principal Investigator, ASCENT ConsortiumHost:Chris Comeaux, President / CEO of TELEIOS, Author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Why does a $64 million NIH grant matter to every healthcare leader, hospice executive, and care provider in America?  Because it has the potential to fundamentally reshape how we care for people at the most vulnerable moments of life.In this episode of TCNtalks / Anatomy of Leadership, host Chris Comeaux sits down with Dr. Jean Kutner—one of the nation’s leading voices in hospice and palliative care research—to unpack a historic moment for the field: a $64 million NIH investment designed to transform care for people with serious illness across the lifespan. More than just a funding milestone, this initiative represents a long-awaited convergence of advocacy, interdisciplinary collaboration, and national prioritization of palliative care research.  Dr. Kutner shares how the ASCENT Consortium is breaking down long-standing silos across disease states, research disciplines, and care settings—creating a unified, trans-NIH strategy that connects researchers, clinicians, policymakers, and patients in unprecedented ways. From accelerating evidence into practice to reimagining care delivery models, this conversation highlights how the future of serious illness care will be shaped not just by innovation, but by intentional collaboration.This episode is for healthcare leaders, hospice professionals, and nonprofit executives, this episode offers a compelling look at what’s next: a future where evidence-based, person-centered care is accessible across the full continuum—from diagnosis to bereavement—and where research translates into real-world impact faster than ever before.Key TakeawaysThe $64M NIH-funded ASCENT initiative is the largest investment in palliative care research to date and marks a transformative moment for the field.  A major focus is breaking down traditional silos across NIH institutes, enabling cross-disease, lifespan-based collaboration.  At least half of the funding is directed toward developing the next generation of researchers through pilot grants and scholar support.  The initiative emphasizes integrating research into real-world care through implementation science and pragmatic clinical trials.  Key innovation areas include care delivery models, symptom management, caregiver support, and improving access for underserved populations.  Guest: Dr. Jean Kutner, Distinguished Professor of Medicine, University of Colorado Anschutz, Chief Academic Officer, UCHealth and Contact Principal Investigator, ASCENT ConsortiumHost:Chris Comeaux,President / CEO of TELEIOS, author of The Anatomy of Leadership Teleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part Two of Private Equity, AI, and the Future of End-of-Life Care, Chris Comeaux and Cordt Kassner dive deeper into the forces reshaping hospice and healthcare.  From the growing influence of private equity to the urgent need for systemic reform, this conversation explores the tension between financial performance and mission-driven care.  The discussion highlights a critical question: can healthcare balance economic sustainability while preserving dignity, compassion, and patient-centered outcomes?  The episode also examines real-world policy shifts and emerging data—from Medicare payment reform signals to increased regulatory scrutiny aimed at eliminating fraud and protecting vulnerable populations.  Beyond policy, the conversation underscores the importance of transparency, accountability, and evidence-based decision-making in shaping the future of hospice care.Ultimately, this episode returns to the heart of hospice: humanity.  Through powerful stories and examples—like pediatric care innovations and “bucket list” programs—it challenges leaders to reclaim the authentic mission of end-of-life care: honoring lives, supporting families, and delivering excellence at the bedside.If this conversation challenged your thinking, share it with your leadership team and colleagues. Subscribe to stay ahead of the trends shaping hospice and healthcare—and most importantly, take one idea from this episode and apply it to improve care at the bedside. The future of end-of-life care depends on leaders willing to act.Key TakeawaysThe U.S. healthcare system faces a looming financial and structural crisis, requiring urgent reform focused on transparency, accountability, and population health.  The role of private equity in hospice remains contested, with concerns about profit-driven models versus emerging data suggesting outcomes may depend on broader operational factors—not ownership alone.  Regulatory efforts, such as Oregon’s Protecting the Dying Act, signal a growing national push to eliminate fraud and safeguard hospice integrity.  Data-driven decision-making is becoming essential, with industry reports and analytics shaping how leaders evaluate quality, utilization, and performance.  Mission-driven innovations—like pediatric programs and life-affirming “bucket list” initiatives—demonstrate how hospice can elevate care quality while reinforcing its core identity.  (This episode is a Top News Stories of Month March 2026)Co-Host:  Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice AnalyticsHost:  Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In this thought-provoking episode, Chris Comeaux and Cordt Kassner unpack some of the most pressing forces shaping the future of end-of-life care—private equity, rising healthcare costs, and the accelerating influence of artificial intelligence. Grounded in real-world stories and industry data, the conversation explores a growing tension between the promise of hospice as a gold-standard care model and the operational, financial, and expectation gaps that providers and families are increasingly experiencing. The discussion dives into systemic challenges, including stagnant reimbursement structures, workforce limitations, and a fragmented healthcare ecosystem that often leaves hospice providers navigating complexity without a clear seat at the broader policy table. As private equity and consolidation trends continue to reshape the landscape, the hosts raise critical questions about whether scale enhances or erodes the deeply human, high-touch nature of hospice care.Looking ahead, the episode broadens into a philosophical and strategic lens—examining how AI may redefine not only care delivery, but the very meaning of being human in healthcare. For leaders across hospice, nonprofit, and healthcare sectors, this conversation offers both a warning and a call to action: innovate thoughtfully, protect what works, and ensure the future of end-of-life care remains anchored in purpose, dignity, and humanity.  Key TakeawaysHospice remains a highly effective and compassionate care model—but growing expectation gaps between families and providers are creating friction.Reimbursement and funding structures have not kept pace with inflation, limiting the ability to deliver comprehensive support.The healthcare system’s pricing inconsistencies and payer mix distortions are creating downstream pressure on hospice providers.Despite consolidation trends, hospice remains a highly fragmented industry, raising important questions about private equity’s role and impact.AI is poised to transform care delivery—but also introduces ethical questions about consciousness, purpose, and the human role in care.(This episode is a Top News Stories of Month March 2026)Co-Host:  Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice AnalyticsHost:  Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In Part Two of this powerful conversation, hospice pioneer Barbara Karnes brings clarity and compassion to one of life’s most misunderstood experiences: the final days of life. With her signature ability to translate complex end-of-life processes into simple, human language, Karnes reframes dying not as a medical failure—but as a natural, deeply human transition. She emphasizes that fear often stems from misunderstanding, and that education is the single most powerful tool to help families navigate this sacred time with confidence and peace.Listeners will gain profound insight into what actually happens as the body begins to shut down—from changes in eating, sleeping, and socialization to the emotional and spiritual realities unfolding beneath the surface. Karnes challenges common misconceptions, including fears around morphine and pain management, and reminds us that it is disease—not dying itself—that causes pain. Through practical guidance and deeply human wisdom, she equips caregivers and clinicians alike to better support both patients and families.At its core, this episode is a call back to purpose. Karnes urges healthcare leaders and hospice professionals to resist the pull toward systems, regulations, and business pressures—and instead refocus on the human being at the center. End-of-life care, she reminds us, is not just clinical work. It is sacred work—an opportunity to guide families through one of the most meaningful moments they will ever experience.5 Key TakeawaysDying is often misunderstood — real end-of-life experiences differ significantly from what people expect based on media portrayals.  Education reduces fear — preparing families with clear, simple explanations helps normalize the dying process and ease anxiety.  The body follows a natural progression — decreased appetite, increased sleep, and withdrawal are expected and mirror the reverse of birth.  Pain is caused by disease, not dying — proper use of comfort medications like morphine is essential and often misunderstood.  Hospice care is sacred, not transactional — the focus must remain on guiding people through a profound human experience, not just managing systems or regulations.  Guest: Barbara Karnes, End of Life Educator and Hospice Pioneer Host:Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

In this powerful conversation, hospice pioneer Barbara Karnes joins TCNtalks / Anatomy of Leadership to unpack with Chris Comeaux what truly happens in the final days of life—and what healthcare professionals often miss. Drawing from over four decades of bedside experience, Barbara shares how hospice care began as a movement outside the traditional medical model, rooted not in treating disease, but in caring for people and their families during life’s most vulnerable moments.  Her insights challenge modern healthcare to return to a more human-centered approach—one that prioritizes presence, education, and compassion.Barbara offers a deeply practical and emotional perspective on the role of hospice professionals as “invisible conductors,” guiding families through fear, uncertainty, and grief.  She explains that while death may be the defining moment, the preparation leading up to it—through education, support, and connection—is what truly shapes the experience for patients and loved ones alike.  This episode also explores the origin story behind her widely influential booklet Gone From My Sight, now distributed in the tens of millions worldwide.  What began as a simple response to families’ fear and confusion became one of the most trusted resources in end-of-life care—reminding us that clarity, simplicity, and empathy are essential in moments that matter most.  5 Key Takeaways:Hospice should prioritize people and families—not just disease.  Education reduces fear at end of life.  Clinicians guide families as an “invisible conductor.”  Self-awareness is essential for effective caregiving.  Clear, simple resources empower families.  Guest: Barbara Karnes, End of Life Educator and Hospice Pioneer Host:Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of LeadershipTeleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast