Home Based Palliative Care A case for access to patient centered services Board Presentation

What is Homebased Palliative Care? Palliative care seeks to improve quality of life for patients and to support families, as they face serious or terminal illness. The focus is on the prevention and relief of suffering through an interdisciplinary team approach to care. This can include medical, physical, emotional, and spiritual assessments and interventions. In home based palliative care models, patients receive care in their home or facility with the goal of preventing unnecessary ER visits and avoiding unwanted (re)hospitalization. Goals of care can be established earlier in the disease trajectory. Board Presentation

All Hospice is Palliative Care but not all Palliative Care is Hospice Board Presentation

Hospice vs. Outpatient Palliative Care Timing -generally considered terminal or having a life expectancy of months or less to be eligible Payment – reimbursable through Medicare, Medi-Cal and private insurance Treatment – comfort care is the focus rather than curative, life prolonging therapies OUTPATIENT PALLIATIVE CARE Timing -No time restrictions. Palliative care can be appropriate whether a patient is terminally ill or not. It is generally agreed that palliative care is for those with advancing illness Payment – Services are not reimbursable by Medicare, new legislation (in CA) allows for Medi-Cal to reimburse, private insurance is negotiable Treatment- can concurrently receive curative treatment alongside symptom management and end of life care planning Board Presentation

Differences in Palliative Care Delivery HOME BASED PALLIATIVE CARE In the patients residence (home or facility) Specialized Care Interdisciplinary Team Case Management Care Coordination Community need (only 18% of California hospitals offer outpatient palliative care) OTHER PALLIATIVE CARE Inpatient Palliative Care – Hospital Based programs (In 2012 the U.S. had more than 1600 inpatient palliative care programs) Outpatient Palliative Care Clinics – Typically associated with and subsidized by a health system Medical Groups – Developing Innovative New models Integrated Care Systems – Kaiser, The VA Board Presentation

Why a Palliative Care Program? Access to expanded services for patients in the community Improved patient outcomes, quality of life Increased patient and family satisfaction Reduced utilization of unnecessary services Generates cost savings for the system Hospice programs have the knowledge to ensure success in Palliative Care Board Presentation

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Barriers to Implementation Financial – difficult to break even Studying the problem too long – needing more data Trying to get buy-in/agreement from all stakeholders Tackling everything at once –scope too large Measuring nothing/everything Assuming that the status quo is OK Board Presentation

Next Steps: Timeline 6 months – 1 year Establish leadership team Identify community partners Develop program policies and procedures Identify interdisciplinary team and staffing Determine scope of services Develop training and education materials Define goals and measureable outcomes Identify funding sources (managed care, Medi-Cal, grants, etc.) Board Presentation

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References California Healthcare Foundation Coalition for Compassionate Care Dartmouth Atlas of Healthcare Jama Internal Medicine TriCentral Palliative Care Toolkit Center to Advance Palliative Care Board Presentation