Innovative Care

    Leadership Matters.

    For over four decades, Four Seasons has set state, national and international innovation benchmarks for Palliative and Hospice Care providing you access to the best advancements in care delivery. In addition, Four Seasons’ Research & Development team leads the nation in healthcare advancements and improvements that benefit the people in our local communities and across the nation.

    • Our Chief Medical Officer, Emerita, Janet Bull, MD, serves as President of the American Academy of Hospice and Palliative Medicine, bringing national advancements in care to our community.
    • Our Palliative Care Chief Medical Officer, John Morris, MD, is ranked within the Top Ten Palliative Care Providers in the nation by the Center to Advance Palliative Care.

    Project ECHO : Funding to expand Palliative Care in the Carolinas

    Project ECHO : Funding to expand Palliative Care in the CarolinasLeveraging telehealth technology, Four Seasons trains and mentors palliative and hospice care teams in rural WNC communities so that people who have a serious illness have access to high quality hospice and palliative care services.

    Four Seasons was awarded $750,000 from The Duke Endowment “Project ECHO to Expand Palliative Care Access Across the Carolinas.” In collaboration with Duke University Medical Center, Delta Care Rx, and the ECHO Institute, Four Seasons will use the Project ECHO (Extension for Community Healthcare Outcomes) model to train and mentor both palliative care teams led by nurse practitioners or physician assistants and primary care providers in rural communities in the Carolinas. Using telehealth, Project ECHO links specialists in that particular field at a “hub” with clinicians in local communities considered the “spokes” of the model. Together the hub and spokes participate in bi-weekly teleECHO clinics that include patient case presentations, didactics around evidence base practices, and mentoring.

    Dr. Janet Bull, the Chief Medical Officer at Four Seasons said, “Workforce shortage issues will continue to impede the delivery of community-based palliative care for patients with serious illnesses. Using the ECHO model, we can reach providers in rural areas who need primary palliative skills along with enhancing skills of those advanced practitioners who lack the support of physicians in their service area. My hope is that demonstration of the value of the ECHO model regionally will allow national expansion, and that persons with serious illness in rural settings will have access to high quality palliative care.”

    Center for Medicare, Medicaid Innovation

    Center for Medicare, Medicaid Innovation

    Four Seasons is a recipient of a Center for Medicare & Medicaid Innovation Award focused on improving patient outcomes and reducing healthcare costs.

    A regional and national leader in the advancement of palliative medicine, Four Seasons The Care You Trust , recently completed a three-year grant with a Centers for Medicare & Medicaid Services Healthcare Innovation (CMMI) award focused on expanding community-based palliative care, improving patient outcomes, improving patient/family satisfaction, while reducing healthcare costs.

    Four Seasons’ community-based palliative care delivery model is one of the best examples of this type of care in the U.S., integrating inpatient and outpatient care, and thereby spanning all settings through which patients with advanced illnesses transition: hospital, clinic, home, assisted living facility, and nursing home. The seamless coordination of a centralized care plan across all sites of healthcare delivery within the patient’s community represents state-of-the-art care within the palliative care spectrum, placing the Four Seasons program at the forefront of the movement to implement, evaluate, and demonstrate community-based palliative care in the U.S.  One of the primary outcomes of the program will be to utilize the results to propose an alternative financing approach for community-based palliative care within the Medicare program.

    “Clinically speaking, palliative care acts as an extra layer of support for patients living with the effects of serious, life-limiting illness on a daily basis,” said Janet Bull, MD, chief medical officer for Four Seasons. “The CMMI grant has allowed our organizations to partner with other regional healthcare leaders to create and sustain a program that will ensure these patients receive direct and comprehensive care where they live. By demonstrating a financially sustainable model, we are confident that more patients will now receive this type of care in the long term.”

    The interdisciplinary community-based palliative care team consists of physicians, physician assistants, nurse practitioners, registered nurses, social workers, and chaplains. Services within the Four Seasons model include symptom management, social work, disease management education, advance care planning, support with complex medical decisions, psychosocial support, and patient/family education. To improve care for minority patients, the model involves hospital-based translator services, and includes cultural competency as part of provider training. The community-based palliative care clinical team is trained to provide patient/family-centered, culturally competent care to Western North Carolina communities, creating a comprehensive catchment net for vulnerable populations.

    “This generous grant from the Center of Medicare and Medicaid has allowed us to make huge advancements in palliative medicine not only for the benefit of residents in our local communities, but for patients who will benefit from palliative care nationally,” said Chris Comeaux, (former) chief executive officer for Four Seasons. “I’m confident that the success achieved by reaching the goals set forth for this program will be a cornerstone for improved healthcare outcomes for patients across the country for years to come.”


    Four Seasons announced as 2-year telehealth grant recipient

    Four Seasons has been awarded a 2-year telehealth grant from the Agency of Healthcare Research and Quality (AHRQ) to evaluate the impact on patients and providers of integrating a virtual pharmacist into a telehealth model in caring for people with serious illness in rural Western North Carolina.

    This study will build on the pilot project previously implemented at Four Seasons as part of a Centers for Medicare and Medicaid Services Healthcare Innovation award. This new platform is called Adapt, powered by the TapCloud application and is offered by DeltaCare Rx, a well-known pharmacy service provider in the hospice industry, with a longstanding relationship with Four Seasons. Adapt will have the ability to interface with the electronic medical record allowing for inter-collaborative practice where the pharmacist will identify drug-drug interactions, recommend appropriate deprescribing, educate on the risks/benefits of new medications, and track side effects from new medications, and clinicians will review pharmacy recommendations and will use e-prescribing as indicated for any medication changes. Patient and caregiver education will occur through virtual pharmacy sessions via Adapts’ video and messaging capabilities. Patient’s will “tap in” their symptoms daily using the remote patient monitoring module and this information will be monitored by both the pharmacist and the clinicians which is especially important after medication changes. All patient health information remains secure and encrypted within the application. The use of telehealth in hospice and palliative medicine allows patients and care teams to better communicate about healthcare concerns and needs and improves response times to patient needs especially in rural areas with little access to healthcare options. The addition of a pharmacist to this care team is unique and one that has the potential to effect care in a seriously ill population significantly. Janet Bull, the Principal Investigator on the project says “pharmacists add tremendous value in identifying harmful medication interactions and providing education to both clinician and patients.  Using virtual technology within a remote patient monitoring application can easily be scaled to those with serious illnesses who are too sick to leave their home settings.”


    To learn more about Four Seasons grant involvement or to gain access to care for yourself or a loved one, visit or call (866) 466.9734.