Partnership Solves One Problem. Measuring Quality Solves the Next.

By Alicia Bloom, COO, Empassion 

In a recent article, we explored why health plans increasingly partner with specialized organizations to support members living with serious illness. From a purely operational standpoint, the rationale is clear: traditional healthcare infrastructure simply wasn’t built to scale the proactive symptom management, advance care planning, and longitudinal, cross-setting support these patients and their families require. 

Partnership bridges that capability gap, but once a health plan delegates this care, a more complex question arises: How do you accurately evaluate the quality of serious illness care? As programs expand and more complex care moves into the home, answering this question is an operational imperative. 

Access Is No Longer the Only Challenge 

Historically, network adequacy was the primary hurdle. The goal was straightforward: ensure members had access to providers. Today, access is just the baseline. For plans managing medically complex populations, ensuring a provider is simply in-network is no longer sufficient. 

As a clinician, I know that two providers might check the same regulatory boxes and offer identical service lines on paper, yet deliver wildly different patient experiences at the bedside. For health plans holding the line on clinical outcomes, member experience, utilization, and total cost of care, identifying these variances is critical. 

The Limits of Traditional Quality Signals 

Quality is notoriously difficult to measure in serious illness care. Traditionally, outcomes are often binary: a screening was completed, a surgical procedure was performed or there was no rehospitalization post-discharge. Serious illness is highly nuanced, and traditional claims-based reporting frequently falls short of capturing clinical reality. 

True quality in this space hinges on outcomes that are difficult to capture through claims alone: 

• Symptom Management: Were symptoms controlled proactively, or did they escalate into an avoidable crisis and hospitalization?
• Goal Alignment: Did the clinical interventions actually align with the patient’s documented values and wishes? 
• Timeliness: Were difficult conversations about disease trajectory initiated early enough to be actionable? Was hospice introduced at the appropriate time? 
• Caregiver Support: Was the family equipped to handle the physical and emotional impact of caregiving? 

These are the questions that determine whether intervention in serious illness care was successful. If we rely solely on retrospective reporting to answer them, the opportunity to intervene and change the trajectory of a patient’s care has usually passed.

The Imperative for Transparency and Continuous Oversight

As health plans increasingly rely on specialized partners, operational transparency is non-negotiable. Payers can no longer accept broad assurances that quality care is being delivered– they require verifiable confidence. 

Effective oversight requires: 

• Visibility into real-time performance trends. 
• Accountability mechanisms capable of flagging clinical or operational drift before it becomes a systemic problem. 
• Objective criteria to separate consistently high-performing organizations from those falling behind. 

In serious illness and end-of-life care, we are navigating the most vulnerable moments of our patients’ lives. Quality failures here aren’t just missed targets— they carry profound consequences for patients, their families and our healthcare system. 

Building Accountability Into the System

The evolution of quality oversight must look beyond whether care was delivered, to how well it was delivered. As we advance deeper into value-based models, holding ourselves accountable to clinical outcomes, patient and caregiver experience, and operational timeliness is essential for all stakeholders. 

Partnership is a necessary strategy for managing complex populations, but it is only the first half of the equation. The second half is ensuring those partnerships reliably deliver the dignified, high-quality care that patients and families deserve. The goal is not simply access to services; it is having the confidence that the care being delivered is worthy of the trust placed in it. 

At Empassion, we recognized this gap between access and accountability. That is why we developed Empassion Assured — to provide health plans with the continuous quality oversight, transparency, and clinical rigor required to evaluate and elevate the standard of serious illness care. We designed this framework to move the industry beyond retrospective review, providing a proactive, transparent mechanism to evaluate provider performance in real time. By establishing objective, measurable standards around the clinical interventions that actually matter, Empassion Assured translates the nuance of serious illness care into actionable data. It delivers the continuous oversight and clinical rigor health plans need, not just to manage a network, but to confidently elevate the standard of care for their most vulnerable members.

Alicia Bloom is Chief Operating Officer of Empassion Health, a national leader in serious illness and hospice care.