Calling Palliative Care
When I was a reporter in the ‘90s, the community hospital Charlotte Hungerford in Torrington Connecticut had 1 palliative care nurse who visited patients before discharge and sometimes went to their home. One time I road around with Barbera to see patients who were 85 or 90, near the end of their life, in great pain and sadness - Barbera was a lifeline, perhaps too late. “I wish I could have been here earlier,” she said to June back in 1997. June had been discharged for her 3rd fall that year. Barbera sang “This little light of mine” and held her hand.
20 years ago, fewer than a third of hospitals with more than 50 beds had a palliative care program. Today, patients can access some level of palliative care in a majority of hospitals but the ability to get palliative care to the home sooner is difficult given staffing shortages. Health insurers are finally starting to address the issues, some forming palliative care teams – one for adults and one for seriously ill children as Regence Blue Cross Blue Shield in the northwest U.S. does. The challenge now is getting palliative care delivered consistently at the right level.
94% of 1,319 adults in one of our polls said they would embrace the idea of palliative care if it gave their parents “another month of quality survival.” Regence BCBS has used a vendor to build an algorithm that’s able to identify patients whose illness is advancing and who would likely benefit from palliative care. It’s probably not much different than the algorithms insurers are using to identify teens at risk of suicide. For seniors, it’s repeated fall risk.
The indicators are difficult for families to come to grips with – just like my own mother-in-law whose ~13 some falls and hospitalizations stemmed from memory loss linked to undiagnosed vascular dementia that led to being orthostatic due to dehydration and not eating. The question will be whether the healthcare system and insurers can develop a structure to pay companies enough to cover all the services that families need. On a white board I saw during a meeting at a Medicare Advantage insurance plan last year, the payment model was sketched out – it read “Case rate: 1 RN visit, 2 MSW visits, 1 doctor video visit, 2 phone calls from MSW, 1 visit from chaplain, $525 PMPM,” which correlates to a per member or per patient per month payment to cover all the services. The question for companies creating palliative care home support is to make sure these monthly case rates don’t just cover services and staff, but also logistics like travel and data exchange and technology needed to capture information. The question for families is a simpler if not more challenging one - how to get their parent into palliative care before the fall cycle starts.