Here is an exerpt from the interview:
MHE: Can you discuss the home-based palliative care program that Medicare beneficiaries can now receive?
Garg: Absolutely. I think the Centers for Medicare and Medicaid services, really the government agency that supports the services and benefits of Medicare and Medicaid, have been on a journey of enhancing the supplemental benefits that Medicare Advantage plans can offer: meals ride sharing other social services, respite care, over the counter medications and therapies that people need for their health. And so the latest slew of benefit enhancements and supplemental programs includes: home based palliative care services, services under palliative care where there's a reasonable expectation of improving health or maintaining health, and that those could be covered by Medicare Advantage plans, which are private entities that have to meet these standards of benefits and services.
And this also allows Medicare Advantage plans to tailor the programs to specific populations. And that's really from a resource stewardship perspective so that people with the means that are aligned can receive those services like home-based palliative care, and really to help target the resources where they're most needed. So people with serious or advanced illness now who were pre-hospice, meaning they're not thought to be in the last six months of life, have access to palliative care services under supplemental benefits for Medicare Advantage plans that have chosen to take that on. Many of the plans are now choosing to add that as a supplemental benefit. Duke University released a recent study that said now 61 different Medicare Advantage providers are offering palliative care as a supplemental benefit. And that's up from 15 in 2019, just the year before, so really a multiplication of support and resources of accessibility for seniors around a very critical domain of health. So I think it's a really fantastic evolution in terms of how we can support our seniors in the needs that they have.
MHE: What are some possible barriers or complications to receiving this program.
Garg: I think the core challenge in palliative care is really around awareness. You know, people who are experiencing serious illness, know they have a serious illness or getting care from multiple groups and providers, you know, our team oncologist, specialists, hospital-based teams. And yet somehow in the moment that unfolds, you may not be aware of what palliative care is or that it could be accessible to them. So I think that's one key opportunity, let's call it, for these programs, as they engage as a supplemental benefit under Medicare Advantage or other supports as patient education, patient awareness, proactive conversations that even this is something that might be useful for you and to have a conversation about it. I think there's not a lot of access to palliative care overall, so many services are hospital-based. This will clearly open the envelope up more. but it's still difficult to always access it in the way that's most convenient. That's where we believe home-based palliative care is a huge opportunity.
MHE: What is your view on the best way to integrate a palliative care into the patient's overall health plan?
Garg: I think that palliative care needs to be integral to all of healthcare. And I think that starts with patient education. Really, the ability to keep people informed about what serious illness means for them, the full spectrum of options, and really the important perspective that palliative care specialists have developed about symptom relief. And making choices that are deeply personal as people advance through their care. They're confronted with new information about what their healthcare trajectory might be. So first, I think critically, patient education, public awareness, accessibility of these programs is really important. We'll fold them in the fabric of all of our care in general, overall. The second is really to take the responsibility in our general care as primary care practitioners. I'm a practicing primary care physician with CareMore and previously I've had patients who've come to me in very severe stages of illness, even getting to the hospice stage where their life expectation was less than six months. And we've handled it all on the outpatient side.
We've had clinic visits, they've gotten the right services as in outpatient blood transfusions, different kinds of services that help their symptoms decrease and help their functionality improve; driven by their preferences and choices. And so as primary care physicians and clinicians in general care practices, I think there's a huge opportunity for us to reintegrate palliative care expertise into our daily practice, really, again, to serve that first point, which is patients have access and awareness. The last point I'd say is a lot of our care in this country is driven by specialty perspective. It's a great part of all the innovation in healthcare that's happened. We have therapies, diagnostics, interventional services, all of that has really occurred in the last 50 years to 70 years, within some of our seniors lifetimes, it's dramatically evolved. Our specialists have important expertise about what diseases mean and what people can expect in their healthcare. But I would suggest that specialty groups which really define the clinical protocols about how we should care for different types of cancer, or different stages of heart failure, integrate palliative care as an important component in consideration at the right moments in a patient's health care trajectory.