Health care provider organizations, payers, and the health policy community increasingly recognize the deficiencies in care for people with serious illness and for those approaching the end of life. While medical advances have provided great benefit to some, many people with serious illness still often experience physical and emotional distress, as well as lack of alignment between their personal values and goals and the medical care they receive.
Multiple studies have shown that specialized palliative care services address these needs in a way that usual care does not. With a focus on defining and adhering to patients’ goals of care, managing pain and symptoms, addressing psychosocial and spiritual issues, and coordinating care among multiple providers and settings, palliative care improves the quality of life and experience of care for people with advanced illness, while also lowering costs by helping patients stay in the care setting of their choice (typically their home).
Despite robust evidence of the benefits of palliative care, growth of these services has been stunted by the lack of sufficient, defined funding streams. Only some members (typically physicians or advance practice nurses) of interdisciplinary palliative care teams can bill for their services; one study found that billing covers less than half of outpatient palliative care service costs.
While some health care organizations are moving toward accountable care models with global payment, where the cost of palliative care services can be offset by the avoidance of unwanted care, this movement has not kept up with the need for more palliative care services. Without a sustainable payment model, the potential of palliative care to address essential care needs cannot be realized. And without palliative care, the complex challenges faced by people with serious illness will not be adequately addressed.
To address these challenges, the California HealthCare Foundation (CHCF) has supported a planning process for ten teams of payer and provider organizations committed to strengthening and spreading palliative care services in California through innovative partnerships.