Why a sustainable palliative care model matters
To achieve a palliative care model that delivers quality patient care in a sustainable way, the details matter. Discussing cost and delivery efficiency regarding someone's serious or life-limiting illness may sound anything but patient-centered. Ignoring sustainability, however, comes at a cost not only to healthcare systems and palliative care doctors, nurse practitioners, and other care team members, but also to patients who need such care.
Here's why engaging in a sustainable palliative care model means better patient care.
What does sustainable palliative care mean?
"Sustainable, to me, means that it is cost-effective and doesn't cause burnout in its providers," says Dr. William Logan, Staff Vice President and National Medical Director at Carelon Health. "At Carelon Health, we not only are cost-conscious — meaning we have balanced cost and revenue — but we also consistently show a significant return on investment. By remaining both fiscally solvent and producing additional value through cost savings over usual care we are, by definition, sustainable."
Sustainability also means providing best-in-class palliative care to achieve desired outcomes for healthcare systems and patients, adds Dr. Logan. The Center to Advance Palliative Care defines best-in-class palliative care as an interdisciplinary team that includes providers from at least three disciplines.
As the largest home-based palliative care organization in the United States, Carelon Health provides a self-sustaining model of care. Nearly 22,000 patients across almost 40 states currently receive home-based Palliative Care from Carelon Health.
Our industry-leading interdisciplinary Palliative Care team includes:
- A doctor who is board-certified in the medical subspecialty called hospice and palliative medicine, or HPM.
- An advanced practice provider with special training in palliative care.
- A palliative care-trained social worker.
"People trained in palliative care don't go into that because it's a high-paying specialty. They go into it because they have a deep heart to connect with patients in that truly sacred space that occurs around serious illness," says Dr. Logan.
“These providers with this kind of heart give so much of themselves in caring for these patients and their caregivers, we must build their self-care into the model of care. We do that through very careful workforce management — keeping their pace manageable.” Burnout was highlighted during the COVID pandemic. Palliative Care from Carelon Health creates a family-type culture in which we care for each other as we care for patients.
Recognizing the benefits of early palliative care prompted Carelon Health's original Palliative Care model — which focused solely on end-of-life care — to evolve. We now provide Palliative Care for patients regardless of disease prognosis, starting as soon as diagnosis.
"Quality of life hasn't always been taken into account when people have been 'fighting' against a disease process," says Dr. Logan. Palliative Care from Carelon Health focuses on improving a patient's quality of life, regardless of the stage of their healthcare journey. Making a place for quality of life in the many priorities of healthcare is one of the highest priorities of Palliative Care.
"We have patients on the path of serious illness, cancer being a good example. Many cancers are eminently curable. But, boy, while they are being treated, their life is a living hell. We can come alongside them in that and help them experience comfort — relieving their suffering," says Dr. Logan. "That's a very powerful thing."
Benefits of patient-centered, coordinated care
Patients with serious illness often must manage primary care and specialty care doctors, nurse practitioners, and other care team members on their own. The care they receive is fragmented and disjointed. Sustainable Palliative Care provided by Carelon Health takes a different approach.
"Lack of coordination between these providers often results in duplicate prescriptions and patient and caregiver confusion," says Dr. Logan. "By having a comanagement approach, Carelon Health providers can come alongside existing providers to coordinate patient care."
Patient-centered Palliative Care begins with an initial comprehensive assessment. The interdisciplinary team will:
- Gather and review all medical records.
- Review and explain the patient's diagnosis and treatment plan.
- Review all the patient's medicines and when and how to take them.
- Establish self-care goals and provide the tools or resources to achieve them.
- Determine social and emotional supportive care needed.
- Discuss advance care planning.
"We are able to focus our care with the appropriate level of intensity — both frequency and modality of care — through a bedside risk-stratification system," Dr. Logan explains. "This allows the team to provide the greatest value by flexing the team's frequency and modality of care based on each patient's needs."
Positive effects of educational and social interventions
No one wants to end up in the emergency room or hospital. These cost-heavy healthcare resources undermine healthcare sustainability. They also put added financial burdens on patients and families. Often, fear is what leads to people going to emergency rooms. By helping patients and caregivers to better understand and manage their diseases, symptoms, and predictable crises, Carelon Health's Palliative Care model puts patients back in control so they are less likely to use healthcare out of fear.
If patients struggle with following their treatment plan or taking their medicines as prescribed, the interdisciplinary team can help. Many times, it's an easy fix. By developing a relationship with patients and caregivers, the Palliative Care team can create a partnership in care. This partnership helps them manage medicine side effects, for example. They can also switch patients to a lower-cost generic medicine if finances are a concern.
Through a 24/7 Palliative Care hotline, patients can speak to a Palliative Care nurse in their own language for questions or concerns any time day or night. Many times, this individualized over-the-phone care avoids unnecessary and expensive trips to the emergency room, says Dr. Logan. Hotline call notes are added to our electronic medical record system to alert the Palliative Care team to potential care needs. The team can interface with the patient's primary care doctor or specialist to arrange follow-up, if needed.
Serious illness can also cause social and financial suffering. Patients and families may face poor social support or lack resources to manage day-to-day care and living. This can include food or housing insecurity.
Carelon Health's social workers become deeply involved in solving for social and financial domains of suffering. "Because of their special training and skills, they often contribute solutions when doctors and other providers are lost," says Dr. Logan.
Advantages of advance care planning
Outside of a palliative care model, doctors are often reluctant to bring up goals of care discussions. Many people associate these discussions with end-of-life planning. While end of life is certainly a time when advance care planning is important, it doesn’t only apply to those facing a terminal illness.
Every patient deserves to have a voice in their healthcare — expressing how they want to experience their care. Not discussing advance care planning early means patients and families may face difficult decisions when emotions are charged or when patients can no longer communicate their wishes.
At the start of Palliative Care, Carelon Health's interdisciplinary team engages all patients and caregivers, regardless of prognosis, in advance care planning discussions. Throughout a patient's healthcare journey, we conduct clinical reviews. If patients are cured of their illness and no longer require Palliative Care, their care can be smoothly transitioned back to their primary care doctor. When treatment stops working, care teams identify whether they are candidates for hospice and can transition them to end-of-life care.
"Most of our patients execute advance care planning documents that help direct healthcare providers in what the patient and family want," says Dr. Logan. "By engaging in Palliative Care and advance care planning, families and caregivers are also empowered to direct their care journey. By giving them a voice and putting them in control, patients and caregivers suffer less."
Beyond the bottom line
As a holistic approach to care, Palliative Care does more than connect the pieces and parts of a patient's healthcare experience.
"More importantly, we really connect with the human experiencing the disease and the human that's at the bedside caring for them," says Dr. Logan. "That's an incredibly valuable piece of Palliative Care. We've figured out how to do that in a sustainable way. Our value doesn't just occur in our ability to save health plans money, although we do that, too."
In the end, what matters most is that a model like Palliative Care from Carelon Health enables the continued ability to deliver, and receive, better healthcare for all. "By being sustainable, we will be available to be impactful to patients for the long run," says Dr. Logan.
