A Better Benefit: Health Plans Try New Approaches to End-of-Life Care

Apr 26, 2013
In the event of serious illness, Californians strongly indicate that they would want to have care that adequately addresses pain and discomfort as well as providing spiritual, social and cultural support - all of which are hallmarks of palliative care. Unfortunately, most patients at the end of life do not receive these services or only receive them much later in the course of care than is considered optimal.

Among the factors affecting access to palliative care is health insureer reimbursement. Most benefits for these services are patterened on the Medicare Hospice Benefit (MHB), which is limited to patients with an expected prognosis of six months or less and prohibits reimbursement for curative care once patients choose palliative-focused care.

This report describes the findings of a scan conducted from August through October of 2012. The study was designed to:
  • Investigate and describe the spectrum of palliative care and hospice benefits and services that California's largest health plans are currently offering or plan to offer soon.
  • Explore the attitudes of health plans and palliative care stakeholders toward coverage of concurrent care (access to hospice or palliative care concurrently with curative or disease-modifying care).
Information for this report was gathered through review of published reports and academic literature, interviews with key stakeholder, and interviews with physician leaders of six of the largest health plans (in terms of enrollment) in California.
  • Once informed about the definition of palliative care, over 80% of consumers in CAPC's public opinion study indicated they would consider using palliative care if they or a loved one had a serious illness. Dissemination of accurate information is vital to increasing use.
  • Funding the Medicare concurrent care demonstration project is the first step toward expanding access to full-service palliative care for seniors.
  • Team-based care leads to the best outcomes, but current limitations on reimbursement are a disincentive to include non-revenue-generating providers on the team.
  • Data show that palliative care teams facilitate both the best outcomes at the lowest cost, even for the most complex and costly patients.
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