NHPCO NewsLine Summer 2018 - 16

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Circle of Life Awards will give top honors in 2019 to up to three programs or organizations. The application for
the 2019 Circle of Life Award is now available online for download. While there may be insufficient time for a
program to submit the detailed nomination application form for the 2019 Awards (the deadline is August 13,
2018), now is an excellent time to learn more about the criteria for nominations and consider submitting next
year for the 2020 award cycle.
NewsLine shares information about Circle of Life Award honorees from recent years who are NHPCO members.
NHPCO salutes these - and all the Circle of Life honorees - for their work that shine a light on excellence and
serve as models for other programs and communities.

2017

BLUEGRASS CARE NAVIGATORS,
LEXINGTON, KENTUCKY

Providing the main hospice care for a large swath of
Kentucky, in an area with some of the nation's most
challenging levels of chronic illness and poverty,
means going beyond the traditional boundaries of
late-life care. For Bluegrass Care Navigators (formerly
Hospice of the Bluegrass), it's meant finding new and
innovative ways to reach people in many settings and
stages of their lives.
So when it was clear that seriously ill patients needed
help in the gaps between hospital and home, for
instance, Bluegrass started a transitional care program,
the only hospice to participate in a federal innovation
research pilot program. The program has since
expanded to multiple locations, including collaboration
with a university hospital and community groups to
extend the transition coaching to homeless individuals.
The organization's recent name change recognizes its
expanded role. The agency includes hospice as well
as transitional care, palliative care, grief care, a
private duty nurse program and a new adult day
health care program. Care Navigators was the name
choice to better reflect how the community sees the
organization. "We are guides. We listen. We help
people on a journey," says CEO Liz Fowler.
Hospice of the Bluegrass has been a name well-known
in the field for decades as an innovator constantly
testing the limits of what a hospice can do. That role
was bolstered not just by a population with significant
health and social needs, but also by the state's unique

NHPCO NewsLine | Summer 2018

certificate-of-need status that gave it a role as the
area's primary hospice (Bluegrass provides hospice
care to more than 5,000 people in 32 counties). With
that goes a profound sense of responsibility for
meeting the needs of the population.
Chief Medical Officer Todd Cote, MD, explains the
organization's approach as being open to any
possibility, but also ensuring that new initiatives are
worthwhile. "Our approach is science-based; we don't
just have a nice idea and jump into it," he says. "We
have well thought-out ideas, we do our research, a
needs assessment, strategize and often do pilot projects
to determine how best to serve our community."
One example is its transitional care program known
as KATS (originally Kentucky Appalachian Transition
Services, now known as Bluegrass Transitional Care).
The program emerged from an insurer's interest in
long-term case management for some of its members
and became part of a demonstration project funded
by the Center for Medicare & Medicaid Innovation to
reduce all-cause readmissions by 20 percent.
Bluegrass partnered with Appalachian Healthcare
System, whose hospitals manage patients with difficult
long-term health challenges. One of its hospitals had one
of the highest readmission rates in the nation. Bluegrass
started by spending nine months studying the root
causes of those problems, which included health
disparities, obesity and lack of primary care. The
transitions program used risk assessment models to

Table of Contents for the Digital Edition of NHPCO NewsLine Summer 2018