Palliative Care Well-Poised to Address Social Determinants of Health

Non-medical needs related to social determinants of health have a significant impact on the trajectory of patients medical care. Community-based palliative care delivered in the home can help patients address these needs, avoiding costly and unnecessary hospitalizations and emergency department visits, according to a recent paper from Turn Key Health.

Social determinants of health include factors such as health literacy, meals, transportation, housing, food insecurity and other non-medical considerations. The Turn Key paper cited the example of an 84-year-old diabetic patient whose refrdgerator was broken, making it impossible to safely store her insulin. She fell behind on her regimen and ended up in the hospital.

Community-best palliative care maybe the best arrow in the quiver to address social determinants.

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“While many physicians and payers recognize the impact of these non-clinical care gaps, they lack a first-hand window into the member’s home to understand the breadth of these challenges that face some of their seriously ill patients and families. Furthermore, physicians are being asked to engage and manage an even greater number of patients who are seriously ill and often require increased engagement and support,” the paper indicated. “The optimal [community-based palliative care] solutions effectively identify clinical and non-clinical issues, evaluate [social determinants of health], improve care and quality of life and enhance the member and caregiver experience.”

Community-based palliative care can reduce total health care costs by 36%, the paper indicated. These services can also reduce hospital admissions by 48%, resulting in 28% cost savings per patient day. In the outpatient setting, community-based palliative care has been shown to reduce emergency department visits by 35% and hospitalizations by 50%.

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 2019 report.

Data like these are boosting payer interest in social determinants as well as palliative care. Beginning this year, the U.S. Centers for Medicare & Medicaid Services allows Medicare Advantage plans to cover supplemental benefits that include services to address social determinants as well as palliative care itself. 

Hospices provide about 50% of home-based palliative care in the United States according to the Center to Advance Palliative Care.

“[Social determinants of health] have become highly relevant to achieving optimal member care coordination because it is designed to identify members who are plagued by social and economic conditions that indicate the greatest need for health improvement. In the process, CMS is redefining how plans and health care providers address end-of-life care,” the Turn Key report concluded. “The expectation is that physicians will play an increased role in the medical management of members with a serious illness who remain in the home setting. This is where [community-based palliative care] comes in … Members benefit from improved outcomes, and together with their caregivers, report increased satisfaction with care.“

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