Palliative care is looking more and more like hospice care, moving programs from the site of treatment—a hospital, nursing home or extended care facility—to the home. While both services provide compassionate care, what often separates them is the curative services offered in a palliative program.
Palliative care is not necessarily only for end-of-life situations but for patients at any point after diagnosis of a severe illness, says Lee Goldberg, project director, Improving End-of-Life Care, The Pew Charitable Trusts.
Under Medicare, patients with six months or fewer to live who are in hospice cannot receive concurrent care, a combination of treatment and compassionate service; however, seniors in private plans are not bound by the ruling.
The Medicare Care Choices Model, which began in January 2016, is a demonstration initiative under the Centers for Medicare & Medicaid Innovation for patients with advanced cancer, congestive heart failure, and chronic obstructive pulmonary disease who are eligible for Medicare hospice benefits.
The study is testing whether allowing concurrent care in hospice leads to additional care coordination, better quality of life, a decrease in hospitalizations and avoidance of preventable health expenditures.
Medicare is not the only insurer rethinking its approach to palliative care. Many managed care organizations are doing so with initiatives such as integrating multidisciplinary care teams—palliative care physicians and nurses, social workers and chaplains; providing home-based and concurrent care and care coordination; and developing care goals and life plans.
The hope is that these changes will reduce costs and improve care quality. For example, cost savings might be generated by taking the time to discuss patient concerns, reconciling those concerns with a family and healthcare team, and ensuring patients are better informed about care options. This in turn, could lead patients to opt against a traditional hospitalization option, or prevent a hospital admission or readmission.
Here's how five health plans are successfully approaching palliative care.
About five years ago, Priority Health, a Michigan-based nonprofit health plan, put palliative care on the front burner with a comprehensive initiative to make the public aware of the availability of services and ensure physicians could deliver them.
Using advanced analytics and clinical data, Priority identified which patients would benefit from palliative care services, including for medical and nonmedical services such as transportation. “We did not want to offer it to members who couldn’t benefit because the program is a covered benefit without a copayment,” says Greg Gadbois, MD, medical director of Priority.
Priority established the Tandem365 initiative, a consortium of long-term care facilities working together to offer home-based care. The model combines medical, behavioral and social healthcare and addresses the needs of patients that are critically ill and unable to access traditional outpatient care due to psychosocial and financial burdens. It relies on a multidisciplinary team to create a life plan for patients.
The initiative has resulted in a 38% decrease in inpatient stays, 52% decrease in emergency department visits, 35% decrease in total cost of care, 46% fewer specialty care visits, and an ROI as much as 4:1, depending on the patient and timing of intervention, Gadbois says.
Priority partners with Aspire Health, which supports patients with serious illnesses, including providing strategies to relieve symptoms and pain, assisting patients in treatment decision making, and offering emotional and spiritual support to patients and caregivers.