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Why Focus on Palliative Care to Achieve Triple Aim? Part II in a Series of FAQs

Considering the fact that CIVHC ‘s expansive charge is to improve the quality of care and bend the cost curve for health care across the state of Colorado, many people wonder why CIVHC has committed to an effort so specific as improving access to high quality palliative care, especially at such an early stage in our organization’s development. Perhaps an organization such as CIVHC should be more focused on “big picture” issues in Colorado, by identifying where we have the greatest opportunities to impact the quality and cost of care for the largest segments of our population. In 2008, the members of CIVHC’s planning committee took on that exercise, and identified palliative care as one of those opportunities.

Back in 2008, here’s what CIVHC’s planning committee knew based on evidence in literature:

  • Almost a third of Medicare's annual budget goes to care for patients in their final year of life, and a third of that amount is spent in the final month.
  • Despite high expenditures, significant gaps still exist in quality of care for persons with advanced illness.
  • The palliative care approach provides a model for well-coordinated, team-based, patient-centered care that can be readily applied across the entire delivery system.

At the time, the planning committee also identified that the mission of CIVHC would be guided by the “Triple Aim.” The Triple Aim framework, as established by the Institute for Healthcare Improvement, states that the optimization of health system performance depends upon the simultaneous pursuit of the three following dimensions:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of the populations; and
  • Reducing the per capita cost of health care.

The evidence of many studies conducted over the years to test the impact of palliative care on quality, patient and family satisfaction, and cost suggest that palliative care has significant potential toward achieving the Triple Aim. Here are a few examples:

  • Palliative care teams take the time to sit down and talk with a patient and his or her family about treatment goals and life goals. The team then identifies clinical interventions or treatments that accurately match those goals. Not only does this ensure an optimal care experience for the patient, it also leads to a reduction in misuse of services and improvement in the efficiency of care.
  • Palliative care teams facilitate transition planning by coordinating care for the most complex and vulnerable patient populations. Patients with multiple medical issues who receive care from palliative care teams have a much higher likelihood of being discharged to safe environments in which their needs and wishes are most successfully addressed. Palliative care services also lead to fewer avoidable hospital readmissions, and fewer days spent in the hospital overall.
  • Palliative care services are available around the clock wherever the patient is, whether at home, in the hospital, or any other type of setting. This level of access improves the continuity of care, reduces the number of trips to the emergency room, and also provides immediate support to manage discomfort and ease anxiety, both for patients and their caregivers.

So, back to the original question, “Why is CIVHC working on palliative care?” Based upon what we know about palliative care’s vast potential to advance our goals of higher quality, lower costs, and better care for Coloradans, the response to that question is simple. Because we must.

Visit our website to learn more about palliative care.

Read Part I, "What's the Difference Between Palliative Care and Hospice Care", and Part III, "What's CIVHC Doing to Address Palliative Care", in the series.

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Great connection to cost and quality (from triple aim); but, could you please say more about how Palliative Care improves population health?
7/17/2012 3:11:04 PM

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