Palliative Care Alliance: A Benefit
for Health Plans and Their Members

PCA was designed to provide a health plan with home-based palliative care solutions. When a home-based service is offered during the hospital discharge plan, patients become aware that they will not be neglected or their needs forgotten once discharged. In an effort to significantly minimize patients’ anxiety or worry, PCA staff collaborates with existing inpatient health care teams to jointly coordinate a plan of care that reinforces the treatment goals that began inside the hospital. The PCA clinician(s) will establish rapport with both patient and caregiver so that there is a seamless transition from hospital to home. In this way, palliative care uses a transitional model using of effective chronic disease management, keeping a patient from unnecessary readmissions for 30 days after discharge and beyond.

Palliative Care Solutions for Health Plans:

  • Provide members with clinician visits at home to address palliative needs
  • Manage members with chronic or serious illness to effectively minimize hospitalization or re-hospitalization
  • Give members an alternative to going to the emergency department
  • Help coordinate discharge plan for patients returning home from the hospital

Palliative Care - A Defining Moment

While there is no disputing that palliative care can lower costs and increase quality care, there are still a rather small percentage of health care professionals who understand palliative care the way that it was intended. Part of the reason for this is that it is still in a relatively experimental stage of development. Medical personnel and patients alike have only recently been introduced to the benefits of palliative care. Because of its overall perplexity in the medical world, palliative care must be fully understood before it can be adopted and utilized. While there seems to be many ways that ‘palliative care’ can be defined, PCA prefers the following definition to describe its service philosophy and provision:

“Palliative Care is specialized medical care for patients with serious illness designed to improve quality of life.  It emphasizes pain and symptom management for patients as well as consultative support and care coordination for patients and families who are in the process of making decisions about their treatment and goals of care.”  (Source: Realizing the Full Benefit of Palliative Care, 2013)

Unlike hospice, palliative care can be delivered to patients simultaneously with curative treatment and at any stage of their illness. It important for providers and medical staff to recognize that palliative care is very distinct from “hospice”. Its philosophical foundation is rooted in comfort for a patient with a serious or chronic illness but not necessarily as an ‘end-of-life’ service. It can therefore be offered as another layer of supportive care during a time when patients truly need the guidance and supervision of a unified team.

The mission of PCA is to provide members a community based palliative care alternative that helps reduce unnecessary hospitalizations.  Through clinical expertise our team educates members and their families to the warning signs and red flags of chronic symptom exacerbation.  In addition, high level medication reconciliation can be initiated and reinforced by PCA physicians and nurses.

Lower Costs and Higher Quality for Health Plans

For decades we have been conditioned to call 9-1-1 in the case of an emergency. Regardless of the status of that emergency or what our personal preference for medical care might be, we’ve been taught to dial those numbers when emergent health problems strike. For people who have significant, chronic health problems however, it isn’t necessarily the best alternative. Several studies have shown that both historically and presently in this country there has been a gross over-utilization of the emergency department and hospitalization in the last months of life. Much of that usage could have been avoided and unnecessary costs drastically reduced if patients had a better alternative that would adequately address their chronic and/or serious illnesses. Consider the following data:

Smith AK et al. Half Of Older Americans Seen In Emergency Department In Last Month Of Life; Most Admitted To Hospital, And Many Die There. Health Affairs, 31, no.6 (2012):1277-1285

Further support for high health system utilization at end of life:

Teno et al. Change in End-of-Life Care for Medicare Beneficiaries Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-477.

Although the chart above demonstrates a decrease in acute care deaths over the previous decade, ICU admissions actually increased during that same period.  So did health care transitions, from one level of care to another, especially within the last three days of life.  With these and other outcomes from studies done to support the purpose for palliative care, the probability that palliative care can yield substantial quality and cost benefits is undeniable. 

The Setting: PCA Will Assist a Patient from Hospital to Home

Palliative care can be offered as an inpatient program however the true success of a health care service such as this is based on its sustainability.  When a member is discharged from the hospital, the palliative philosophy must translate into the patient’s home environment.  If the building blocks erected by the inpatient provider team aren’t addressed beyond the hospital walls then the work done to prevent recurring health crises, including re-hospitalization will be compromised.

The answer can be as simple as three letters.  PCA.  For members suffering with chronic or serious illness, the PCA team will provide alternatives that will lower costs by giving members the best opportunity to be well.  PCA can follow patients as they transition from the hospital setting into their own residence.   In this way, the palliative work that was initiated inside the hospital can be augmented by the community based clinical team to help ensure that a member receives continuity of care in the comfort of home.