Tennessee Initiative Working to Expand Palliative Care

A major statewide initiative is underway in Tennessee to expand awareness and utilization of palliative care. The project involves state agencies, hospices and other health care providers, along with health care advocacy groups.

The effort has its roots in a 2018 state law that established a Palliative Care and Quality of Life Advisory Council, designed to study and raise awareness of palliative care in Tennessee. The council was born out of the work of a palliative care task force helmed by the state’s Commission on Aging and Disability.

Such laws are part of a growing trend among states. As of Dec. 2018, 27 states have laws on their books designed to promote palliative care, according to the National Academy of State Health Policy (NASHP). Though details of the legislation vary among the states, they each serve the goal of bringing palliative care to more patients with serious, chronic, or life-limiting conditions.

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“The Tennessee legislature created this body and gave it a directive and goals. This project was one of the results of that body working together with other groups to achieve those directives,” Maegan Carr Martin, executive director of the Tennessee Association for Home Care (TAHC), told Hospice News. “The directive of the council is really to prevent and review the barriers that exist that prevent palliative care from being utilized. It’s really to try to expand utilization of palliative care. Our values were aligned toward getting some high quality education on palliative care into Tennessee, and it felt like the stars kind of aligned for us.”

The state charged the council with assessing the current status of palliative care in Tennessee, identifying barriers to and services and resources for addressing the needs of individuals who could benefit from palliative care, and develop recommendations to address problems associated with the availability of palliative care.

Interest in palliative care is growing among health care providers (including hospices), payers and policymakers due to the substantial potential savings in health care costs and the need to care for an aging population, a high proportion of which suffers from serious or chronic illness.

Palliative care consultation can reduce direct hospital costs by $3,000 per patient admitted, and up to $4,800 per admission for patients suffering from four or more diagnoses, according to a 2018 study. It can also reduce the frequency of 911 calls, emergency department visits, and unnecessary hospitalizations.

Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a report.

The partnership has made recommendations related to providers, patients, and systematic/structural issues, designed to provide a framework for increasing access to palliative care across the state. These include programs to ensure that the public, health care providers and other stakeholders have comprehensive, accurate information on palliative care; establishment of a formal definition for palliative care; studies of current and potential payment models for palliative care, and engaging provider and clinicals to better understand the strengths, weaknesses, and needs of the palliative care workforce in Tennessee.

“Education and outreach is a priority. There is still a lot of misinformation and misunderstanding, so that’s what we focused this whole year on,” Anna Lea Cothron, aging commission liaison for the Tennessee Commission on Aging and Disability, said. “We are examining what worked and what didn’t, and now we are in the process of brainstorming some other outreach. It’s a good mix of government, nonprofit organizations and experts all working together to really on behalf of our constituents. We each bring something different to the table, and I think it’s really worked well for our state.”

Activities for the council’s first year included promotion of palliative care education materials online on a Commission on Aging-run website that has garnered more than 500 hits since its launch two months ago.

The group also held a conference in September that brought together 140 stakeholders, including government staff, clinicians, health care organizations, lawyers and finance professionals to learn about palliative care.

“We have continued to involve anybody and everybody possible that cares about this work. When we have done education in the past it’s tended to be preaching to the choir; for the Palliative Care Summit this year we focused on getting outside of that box,” said Mike Dietrich, vice president of member services for the Tennessee Hospital Association. “Many health care organizations have a good idea of what palliative care is, but have no great mechanism to start a program. We are connecting those folks with some of the experts in the area. That is a major way to advance this work: How do we help the providers really get their arms around starting maintaining and growing a program?”

The Tennessee Hospital Association approached the council as a potential collaborator after receiving a separate grant from the state Department of Health to advance palliative care.

Plans for 2020 include further outreach such as offering education programs at community and membership organizations as well as development of toolkits the council will provide to health care associations in the state to bolster those organization’s own efforts. The council is also planning another conference for next year.

A key initiative going forward will be to boost engagement with payers in the state to explore possible payment models.

“A big next step would be to make sure that we have a payer environment to support that continuum of services. Our payers have got real interest in trying to make that a reality,” Dietrich said. “We need to know who is paying for it and who is not and figure out what we can do collectively.”

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