MAKE THE CASE
THE VALUE CASE: HOW PALLIATIVE CARE SUPPORTS THE QUINTUPLE AIM
A robust body of evidence demonstrates that palliative care enhances clinical outcomes, quality of life, and patient experience, while also mitigating the cost of care by anticipating and averting crises and reducing unnecessary or unwanted interventions. Additionally, an emerging body of evidence suggests that palliative care enhances the provider experience, by mitigating provider burnout and alleviating moral distress, and can improve equity through whole-person care. In this section of the toolkit, you will find evidence and testimonials from other health plan leaders that you can use to build your business case, as well as a video (below) you can share directly with health plan decision makers to help them understand the value case for palliative care.
Lessons Learned from California’s Palliative Care Evolution: The Value Case for Palliative Care
In this video, health plan leaders describe palliative care's value to their organizations: enhancing clinical outcomes, equity, quality of life, and member experience, while mitigating unnecessary costs of care.
Highlights of selected literature describing palliative care's impacts on health outcomes, patient experience, and cost of care across settings are presented in Table Two. A more comprehensive list of these studies can be found in Appendix One. Selected literature includes randomized control trials, well-designed observational studies, systematic reviews, and multi-site studies. Many of the featured studies looked at impact across domains (e.g., assessing both patient experience and costs of care for the same population). The evidence shows that palliative care simultaneously improves health, patient experience, and economic outcomes—the gold standard for quality in health care.
Palliative Care Improves Health Outcomes, Patient Experience, and Cost of Care
If you invest in providing palliative care—staffing and services—the cost of care goes down more than the cost of a palliative care program. We do an analysis each month and each quarter to look at the financial return on investment and still find that the amount of dollars saved from hospitalizations is greater than the expense.
Robert Moore, MD, MPH, Chief Medical Officer
Partnership HealthPlan of California
Health and Quality of Life Outcomes
Improved pain, nausea, dyspnea, and anxiety
Better experience of care and patient-reported quality of communication with providers, and satisfied family caregivers
Lower hospital costs, fewer readmissions, greater use of hospice and longer hospice length of service
Inpatient Sample Finding
87% of palliative care recipients had improvement in pain or other symptoms
95% of family caregivers surveyed by phone said they would recommend the palliative care service to others
Direct costs of hospital care were 28% lower among palliative care recipients
Improved quality of life and reduced symptom burden
Improved patient and family satisfaction
Lower costs in the final six months of life driven by fewer hospitalizations, less Intensive Care Unit use, and fewer emergency department visits
Outpatient/Clinic Sample Finding
Compared to usual care, fewer palliative care recipients had depressive symptoms (16% vs. 38%)
At four months post clinic enrollment, patients who were randomized to palliative care had greater improvement in satisfaction compared to usual care patients
Costs for inpatient care in the last month of life were 26% lower when patients received earlier palliative care through outpatient clinics
High satisfaction among patients, caregivers, and referring providers
Lower total costs of care driven by fewer hospital admissions, fewer outpatient emergency department visits, and greater use of hospice
Home Sample Finding
Post-enrollment improvements seen in anxiety, appetite, dyspnea, well-being, depression, and nausea
Patients, caregivers, and physicians reported high satisfaction (93%-96%) with the palliative care program
Overall costs were 33% lower for home-based palliative care patients
A more comprehensive list of these studies can be found in Appendix One.
Table Two: Summary of Evidence Demonstrating Palliative Care Benefits
Within a health plan, generally what people will focus on is the cost. There is definitely cost savings when implementing or offering palliative care to the members. But let's look at other things. Let's look at the existential value. Let's look at the social or emotional or psychosocial value. Let's look at the quality-of-life aspect. All of that can be achieved when offering palliative care. There’s the value right there. Human life.
Kim Beverly, MSW, MSG, Palliative Care Clinical Program Manager
Blue Shield of California
Expert assistance with complex symptom management.
Facilitation of challenging (and time-consuming) patient and family discussions regarding prognosis, goals of care, and treatment decisions.
Self-care and wellness techniques to handle grief and loss.
Assistance in navigating other services related to serious illness, such as home health, hospice, and services offered by community-based organizations.
Palliative Care Improves Provider Well-Being
Anecdotal evidence from palliative care leaders suggests that specialty palliative care teams improve the well-being of other treating providers by saving them time, and by managing complex symptoms and situations that they may not have the expertise to address independently. Palliative care services contributing to provider well-being include:
A 66-year-old female, suffering from out-of-control pain from calcinosis due to long-term dialysis, presented a challenging situation. The patient’s screams and resistance to care were not only frightening other patients, but also posed a source of frustration for the nurses. The expert pain control provided by the palliative care team played a pivotal role. It allowed the patient to cooperate with the care plan and agree to treatment, as she could now imagine a tolerable quality of life, which eased the frustration the nursing staff was experiencing. For the patient's family, the prospect of taking her home became significantly more comfortable as they witnessed that effective pain management was achievable through oral medications.
— Case example from a California public health care system, featured in Meeting the Need: Understanding the Impact of Palliative Care in California’s Public Hospitals
'They [the family] have given him this beautiful, lovely life. And I think that right now his body's too tired. And this is the time to say goodbye.' Sometimes the palliative care doctor being able to take that difficult moment and say those words is a little bit of a relief to the other doctors who may be struggling with delivering the heart breaking information.
Kimberly Bower, MD, Medical Director
Blue Shield of California
By providing individualized whole-person care, palliative care can contribute to addressing health equity for people of color and other historically marginalized groups. While additional research is necessary to demonstrate that palliative care improves equity, the following rationale and testimonial can be used to help make the case.
Palliative Care Addresses Equity
Rationale of how palliative care addresses equity
Through its core tenets and practices, palliative care aims to comprehensively address an individual’s medical, psychological, social, and spiritual needs. Additionally, palliative care plays a crucial role in alleviating various forms of suffering resulting from racial inequities among Americans with serious illness. These include disparities in pain assessment and pain management, challenges related to communication and trust between clinicians and patients, and an outsized burden on family caregivers from communities of color.
The interdisciplinary palliative care team—comprising physician, nurse, social worker, and chaplain—is also often better equipped than other parts of the health care system to address these needs once identified. For example, palliative care teams have expertise in addressing social determinants of health, connecting people with other medical and non-medical services, and operating within a patient's community norms and value system to explain the benefits of various services, even when a patient may lack trust in the healthcare system due to experiences of racism and discrimination. Addressing the multifaceted nature of serious illness on an individual level can improve the experience of care and increase the likelihood of more equitable care.
Palliative care really helps us address health equity because it helps us meet patients where they are within their community and within whatever life circumstance that they're in. And it lets us take care of them with an interdisciplinary team. So, a doctor, nurse, social worker, spiritual counselor can address all of those things that people need when they're vulnerable and may be disenfranchised from our healthcare system or lack trust in the healthcare system.
Kimberly Bower, MD, Medical Director
Blue Shield of California