Center for Improving Value in Health Care
Sep 4, 2012 | 0 comments | Posted by
End-of-Life Care, Palliative Care, Delivery System Redesign
In Parts I and II of my series, “What is Palliative Care?”, and “Why Focus on Palliative Care?”, I explained why palliative care has become a specific focus area for CIVHC to address the Triple Aim of improving health, enhancing health care quality and containing costs. In this final post, I'll explain CIVHC’s work to date convening task forces and implementing recommendations to address palliative care Triple Aim opportunities.
Our work in palliative care began in earnest when we convened a task force to address palliative care issues in 2009. Led by Jean Kutner, MD, a palliative care physician at the University of Colorado Hospital and nationally renowned palliative care researcher, the group was comprised of hospice and palliative care providers, consumers, and affiliated organizations. Over the course of a year, the task force developed a set of recommendations to improve access to high-quality palliative care summarized below.
Defining Palliative Care for Colorado
A national survey commissioned by the Center to Advance Palliative Care (CACP) in 2011 suggested that 70% of the general public does not know what the term palliative care means. Because the term is used by care providers differently and terms such as “comfort care” or “end-of-life care” are frequently used interchangeably with palliative care, the term is very difficult for many people, even those working in health care, to fully understand.
To address this, CIVHC partnered with members of the Colorado Center for Hospice and Palliative Care and other stakeholders to develop a statutory definition and criteria for quality palliative care. The purpose was to create a common language for providers, consumers, and regulatory entities, and to provide clarity for discussions with payers and providers about creating payment methodologies and delivery system changes to promote the integration of palliative care services. The definition and criteria was provided to the Colorado Department of Public Health and Environment to be submitted into statute for licensure and subsequent reporting purposes.
Providing Palliative Care in the Right Settings
The task force identified that many patients who reside in long term care facilities receive concurrent care from hospice agencies that closely coordinate with the facilities, however, the concept of providing palliative care earlier to meet patients’ needs before they approach end of life is less common. To support greater access to palliative care for patients in long-term care settings, CIVHC pulled together a work group to revise a document originally created over a decade ago to guide the provision of palliative care in long-term care settings. The resulting “Palliative Care Best Practices: A Guide for Long-Term Care and Hospice” document is available as a resource to assist long term care, assisted living and home health agencies with providing high quality, efficient, patient-centered care.
Measuring Where Palliative Care Occurs and Consumer Engagement
Within their recommendations, the task force identified the need to address a significant gap in the ability to identify where palliative care is provided across Colorado. Currently there is no clearly established reimbursement structure for palliative care services or consistent metrics, thus it is difficult to quantify the availability of palliative care in Colorado. This presents a challenge when attempting to determine gaps in access to palliative care services and overall capacity to meet the needs of the state’s population. In recent months, CIVHC commissioned the Colorado Health Institute to conduct an in-depth analysis of where palliative care services (both inpatient and outpatient) are provided in Colorado via hospitals, hospices, nursing facilities, and home health agencies. Initial results of this analysis will be available in early fall 2012.
In addition, a recommendation was made to identify strategies to engage consumers, patients, and families in education and outreach around palliative care. The work group addressing this recommendation determined to first gain a better understanding of health care consumers’ current understanding, knowledge and attitudes related to the topics of palliative care, hospice, end-of-life issues, and advance care planning. Currently, there is no Colorado-specific data on consumer knowledge and attitudes toward palliative care, however, other states have conducted research in this area. Experts in the field agreed that it is reasonable to assume that knowledge and attitudes about palliative care are not significantly different in Colorado than in other parts of the country. CIVHC has contracted with the Colorado Health Institute to provide an analysis of this data to help us better understand how this information might help us better understand the knowledge and attitudes of Colorado’s health care consumers.
Paying for Palliative Care
A critical recommendation of the task force was to work with public and private payers and employers to create payment mechanisms for comprehensive palliative care services. To date, a wealth of palliative care research has suggested the positive impact of palliative care services on patient and family satisfaction and overall quality of patient care. There is also substantial evidence to suggest that palliative care lowers overall health care costs, however, no studies have been conducted to date to determine the cost impact in Colorado. Thus, the task force identified the need to quantify the overall health care cost savings related to palliative care interventions as an initial step to make payers aware of the financial benefits of paying for palliative care.
To accomplish this, CIVHC initiated a partnership with CAPC, Mt. Sinai Medical Center, the University of Colorado, and the Department of Health Care Policy and Financing to replicate and expand upon an analysis conducted in New York State revealing the impact of palliative care on costs for the Medicaid population. Among the hospitals studied in NY, the analysis concluded that “on average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care.”
In the Colorado Medicaid Palliative Care Study, fourteen hospitals are participating in a retrospective analysis of hospital administrative and Medicaid claims data from years 2006-2010. Adult Medicaid beneficiaries with advanced illness receiving palliative care are then matched to patients who had not received palliative care services through propensity scoring to determine the difference in overall health care costs related to palliative care interventions. Final results of this study will be available in early 2013.
In conjunction with our efforts to make the business case for palliative care, CIVHC recently convened a work group charged with exploring opportunities within CIVHC’s payment reform efforts that will expand access to palliative care services within different payment methodologies, such as global payments, bundled payments, and financial incentives for improved care coordination.
Over the next several months, this group will engage in conversations payers across Colorado to build awareness around the value proposition for palliative care and potential reimbursement strategies. This group will also explore opportunities for potential Colorado demonstrations to test new payment methodologies that incentivize increased integration of palliative care services within the delivery system.
Visit CIVHC's palliative care section of our website for more information or contact me at firstname.lastname@example.org.
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