Many of you are aware of hospice, either as inpatient or free standing service, which is a program providing a comprehensive set of services. These services include those that offer comfort and assistance to terminally ill patients with less than 6 months to live. In addition to these hospice patients, many patients with more than 6 months to live, could benefit from palliative care services. To fill this void Partnership HealthPlan of California (PHC) is currently sponsoring a pilot program in four counties that offer palliative care services to members who are at a late stage of illness.
Palliative care is an interdisciplinary set of services that aim to improve the quality of life for patients with serious, end-stage illness. These services include symptom management such as pain control, psychological, spiritual, and social support, and logistic support for end of life planning. The principle distinguishing factor between hospice and palliative care is the role of curative care. Hospice patients have explicitly foregone continuance of curative therapy. Palliative care patients may elect to continue a variety of curative care interventions while receiving support care interventions. As such, hospice is a subset of palliative care occurring late in the course of a patient’s life.
The PHC Partners in Palliative Care (PPC) pilot involves palliative care and hospice providers in four counties: ResolutionCare in Eureka, Interim Home Healthcare and Hospice in Redding, Napa Valley Hospice and Adult Day Services in Napa and Yolo Hospice in Davis. As part of the pilot program, these four organizations have committed to providing assessments in the home, 24/7 telephonic support, pain and symptom management, advance care planning and case management. This pilot program began on September 1 and will continue for 6 months.
Which of your patients would be a candidate for palliative care services?. A 2013 PHC analysis of the causes of death for its MediCal members indicates that heart disease (26%), cancer(18%), and COPD (7%) are the most frequent. Through palliative care pilot program, services are being extended to patients who have less than 24 months life expectancy who have stage IV cancer, congestive heart failure, cirrhosis, COPD, dementia or frailty syndrome. Consistent with the Triple Aim – improving patient care, improving the experience of care, and reducing costs- this palliative care pilot program has a goal of increasing the value of care to PHC members at the end of life. For instance, MediCal members often die in institutional settings. The place of death for MediCal members in 2013 were hospital inpatient (37%), nursing home (26%), home (25%) and hospice (1.4%). Dying in hospital or another institutional setting is frequently at odds with the patients end of life wishes. Palliative care services soften the landing by providing interdisciplinary team care to meet their physical, spiritual and mental needs, preferably in their own home. The goal of the PHC pilot program is to honor the choices of our members with an earlier transition to palliative care when appropriate and to see fewer patients with terminal illness spend their last days in the hospital.
The PPC pilot will help us implement the upcoming SB1004 legislation (Hernandez 2014) which extends palliative care to MediCal beneficiaries throughout the state of California. DHCS has not yet specified the eligible conditions, services and providers for palliative care for MediCal members, but we hope to influence that process in a positive way by the experience we gain in the Partners in Palliative Care pilot program.