For Center to Advance Palliative Care CEO Brynn Bowman, palliative care represents a fundamental shift in health care delivery as it continues to grow and make an impact on facilities and patients.

As a CAPC strategist and recognized leader in palliative care education, Bowman’s work has been instrumental in fostering clinician engagement strategies to equip the U.S. health care workforce with the skills necessary to care for seriously ill patients and their families. She and Dr. Diane Meier, founder, director emerita, and strategic medical advisor to CAPC, recently discussed the current state of palliative care in the United States.

Palliative Care News recently spoke with Bowman about the current palliative care landscape and how CAPC is engaged in the field.

Where is palliative care currently being delivered (hospitals, the home setting, clinics?)

Palliative care started primarily as an inpatient, consultative model. Over the last 10 years, more and more specialty palliative care teams are serving patients in their place of residence or in outpatient or community clinics.

While we believe that every patient with serious illness should have access to palliative care, specialists should they need an added layer of support, it is still the case that there are gaps in access to palliative care – particularly in community settings, rural areas and in for-profit hospitals.

What kind of care are these patients receiving? Are the care models consistent?

Palliative care sees the person beyond the disease. It is a fundamental shift in health care delivery.

Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.

Palliative care is provided by a specialty-trained team of doctors, nurses, social workers and chaplains who work together with a patient’s other treating clinicians to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Palliative care services including skilled conversations with patients and families to understand their goals of care, managing pain and other symptoms, support for family caregivers, care coordination, and addressing patients’ social, psychological and spiritual sources of suffering.

What are the biggest obstacles for people seeking palliative care services?

While the large majority of U.S. hospitals with more than 50 beds have a palliative care team, many patients receiving care in outpatient or community settings may not have access to palliative care specialists.

A major reason for these gaps in access is the lack of a standard payment model to finance palliative care services – there is no Medicare benefit for palliative care, nor do most private insurance companies include palliative care benefits in their coverage.

Palliative care providers can and do bill for the time they spend with patients, but fee-for-service reimbursement is not adequate or appropriate to cover the work of interdisciplinary palliative care teams, which include health professionals like chaplains who cannot bill for their services.

Are there ways to mitigate those obstacles?

Many palliative care teams are now contracting directly with health plans – both Medicare Advantage and commercial – to cover the costs of their services.

For plans, the goal is to support high-need members with serious illnesses while reducing avoidable and high-cost hospital utilization. There are also opportunities in Medicaid. California passed legislation that requires access to palliative care for MediCal beneficiaries, and a number of other states are exploring opportunities to connect Medicaid recipients with palliative care services.

The field is also engaged in policy advocacy (particularly from the National Coalition for Hospice and Palliative Care, and the Coalition to Transform Advanced Care) to advance supportive payment models for palliative care.

Where do you see the palliative care field going during the next five years? What will a near-term future state look like?

CAPC’s vision is “Palliative Care Everywhere,” which means that the health system meets the palliative care needs of all patients with serious illness, in every setting, every time.

We think about this both in the micro (what is happening inside of hospitals, clinics and patients’ homes on any given day) and in the macro (what are the levers by which positive systemic change could be made nationally on behalf of patients and families). 

I believe we will see health systems, health plans and community-based providers evolve care delivery and payment models that are high value, that address patients’ social needs, bridge gaps in access to palliative care, and match care delivery to the needs of specific patient populations.

The positive outcomes of palliative care are well-documented, but it is true that person-centered, high-quality palliative care is a resource-intensive service.

For this reason, stakeholders across U.S. health care continue to refine efficient, high-value models of palliative care delivery that align the intensity of service to the intensity of patient needs. This is particularly true in community settings (patient homes, nursing homes, clinics) and in telehealth palliative care models, where we see an enormous amount of innovation.