Regional variation in referral to Palliative Care: What does it mean?

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

Partnership HealthPlan’s new Intensive Palliative Care Benefit has been in place since last winter, but we are seeing wide variation in its use.

In Mendocino, Humboldt and Del Norte Counties, we are seeing strong use of the program, with over 80 patients currently enrolled.  In all the remaining counties, enrollment rates have been very low.

Several studies of intensive outpatient palliative care have shown:

  1. Excellent patient experience/better quality of life
  2. Patients live longer (not shorter)
  3. Health care costs are significantly lower, mostly due to decreased hospital use in the month before death.

What is the explanation for under-use of palliative care in 11 out of 14 counties?

It is not due to an inadequate network.  Partnership has worked diligently to provide a network of intensive palliative care providers that can cover all parts of our service area, including remote frontier areas.

It is also not due to having few patients who qualify.  The eligibility criteria includes:

  1. Stage 3-4 Cancer
  2. Advanced cirrhosis/liver disease
  3. Severe COPD
  4. Severe CHF

Other patients with advanced disease but without these 4 conditions may not be eligible for the full benefit, but may still be referred to palliative care for a comprehensive evaluation with development of a treatment plan.

If you aren’t sure if a patient qualifies:  make the referral!  The palliative care team will assess the patient and get them on the right track.

Low rates of use of intensive outpatient palliative care are primarily related to low rates of referrals of appropriate patients.  Specialists, hospitalists, and primary care physicians are not identifying patients who are good candidates and referring them to their palliative care colleagues for evaluation and management.  Many physicians interpret the term “palliative care” as being the same as hospice.   While hospice care is part of the spectrum of palliative care, the rules for enrollment into hospice are rather rigid:  no curative care; patient expected to live 6 months or less.     In intensive outpatient palliative care, the patient has an expected life expectancy of less than 1 year, and may be receiving concurrent care whose goal is to cure the disease or otherwise ameliorate symptoms.

Which organizations are providing Intensive Outpatient Palliative Care in your region?  See the chart below.


Counties Served Organization Referrals
Del Norte Resolution Care Phone: 707-442-5683
Humboldt Resolution Care Phone: 707-442-5683
Lake Hospice Services of Lake County Phone: 707-263-6270 ext 140
Lassen Resolution Care Phone: 707-442-5683
Marin Hospice by the Bay Phone: 415-444-9510
Mendocino Resolution Care Phone: 707-442-5683
Modoc Resolution Care Phone: 707-442-5683
Napa Collabria Care Phone: 707-258-9080
Shasta (Redding vicinity)Shasta Medical Home Care Professionals Phone: 530.226.5577
Resolution Care Phone: 707-442-5683
Siskiyou (Yreka vicinity) Madrone Hospice Phone: 530-842-3160
Resolution Care Phone: 707-442-5683
SolanoSolano (Vallejo) Continuum Hospice Phone: 707-540-9838
Collabria Care Phone: 707-258-9080
Sonoma Collabria Care Phone: 707-258-9080
Hospice By the Bay Phone: 415-444-9510
Trinity Resolution Care Phone: 707-442-5683
Yolo Dignity Health – WoodlandYolo Hospice Phone: 916-281-2370Phone: 530-758-5566

Get help for your patients who are nearing the end of their lives, but may not be ready for hospice.  Refer them to your local palliative care team!

Robert Moore, MD MPH

Chief Medical Officer



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