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Palliative Care: Good Business and the Right Thing to Do

Analysis  |  By Debra Shute  
   April 13, 2017

AMGA presenters shared advice on finding the right candidates for palliative care, at the right time, for the right reasons.

In a value-based environment, palliative care programs can translate to substantial savings. A recent study published in the Journal of Palliative Medicine calculated the savings derived from a home-based palliative care program (HBPC) at $12,000 per patient during the final three months of life compared to patients receiving usual care.

But when it comes to marketing this extra layer of support to patients or referring physicians, it's important not to overemphasize the financial benefits, says Dana Lustbader, MD, chair of the department of palliative care for ProHEALTH in New York.

She co-authored the study and spoke about medical group models for palliative care at the American Medical Group Association's 2017 Annual Conference, in Grapevine, Texas, March 22 – 25.


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Sell Support, Not Savings

"We have a branding problem with the word palliative," she said. "Most of the public doesn't know what advanced illness is, either. They do have an understanding of what it means to be seriously ill or have a serious illness, and they like having an extra layer of support."

For that reason, palliative care providers typically explain to patients that they provide supportive care, and rarely if ever use the term palliative care. "Most of the patients we serve just know that their nurse Mary or social worker Lisa are fantastic," Lustbader said.

She continued: "We do show a lot of cost savings with palliative care, which can help ACOs and physician groups think about building and paying for a palliative care program. But that's not the driver of why we do this. It's just the right thing to do; and it just so happens that better care costs less money."

And that better care is evidenced by quality metrics such as patients spending more time at home, experiencing less pain and fewer symptoms, and being much less likely to die in the hospital.

In fact, Lustbader and colleagues found that most of the cost savings were derived from a 34% reduction in hospital admissions in the final month of life for patients enrolled in the HBPC. What's more, 87% of ProHEALTH palliative care enrollees who died did so at home, compared with New York's average death-at-home rate of 25%.

Find the Right Patients
The most critical factor in successfully achieving quality and financial goals, however, is in identifying the most appropriate patients for the service, conference presenters agreed.

Finding patients at the top-quartile of risk for mortality, frailty, comorbid conditions, and functional limitations is best done using a combination of algorithms and patient-screening tools to identify addressable gaps in care, said Mitchell Mudra, MBA, chief operating officer at Optum.

"You can have the best palliative care program in the world, but if you're finding patients who aren't appropriate for the intervention, you're going to be wasting intensive resources," Mudra added.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.


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