Palliative care and its core principles may be driving incremental change in the larger health care system.

Some of this is likely due to necessity as the nation strains to manage the extensive needs and expensive costs associated with the care of the growing chronically ill senior population. Currently, more than 10,000 individuals become Medicare-eligible each day, a trend expected to last for several more years, according to the Kaiser Family Foundation. Close to 80% will have at least one chronic or serious illness.

In the midst of this, palliative care is starting to wield some influence, though in a slow, fragmented way, Logan Hoover, vice president of health policy and government relations at the National Hospice and Palliative Care Organization (NHPCO), said at the Hospice News Palliative Care Conference in Tampa, Florida.

“Everyone kind of wants to say they do palliative care, and everyone wants to say, they’re holistic: ‘We take care of the full body, the full mind, the full patient, the full family.’ But I think everyone defines that very differently,” Hoover told Palliative Care News at the conference. “That’s a political risk that we have. The more abstract we are, the more ill defined we are, the harder it is for us to then actually be recognized system-wide and have sort of an overarching system of reimbursement and payment.”

Wide variation still exists in how providers deliver palliative care. While some offer a full scope of interdisciplinary care, some palliative care programs only offer physician consulting services or advance care planning.

Others limit services to certain types of support for pain management. This broad brush can be confusing for referral sources, payers and patients and families who may not understand what they are getting or what else may be available to them.

Nevertheless, palliative care, depending on how it’s delivered and paid for, can help drive change in the health care system, in terms of cost reductions, improving outcomes and making care more patient-centered.

But while the flexible definition of those services can give providers room to innovate, positive change has been slow going, according to Scott Levy, chief government affairs officer for Amedisys (NASDAQ: AMED).

“There are incremental signs, because I think in a lot of the discussions that we’re having from the provider level, there is a desire from the referrals to see some sort of palliative care,”’” Levy said at the conference. “It’s kind of amorphous in what it looks like, and they don’t really know what they’re asking. Everybody wants to innovate. But what exactly do you mean, when you say you want to innovate?”

Palliative care in general can reduce health care costs by more than $4,000 per patient, according to a July 2017 study in Health Affairs. It can also reduce the frequency of 911 calls, emergency department visits, and unnecessary hospitalizations.

However, close to 60% of patients who would benefit from palliative care do not receive those services, despite the availability of community-based palliative care as well as hospital-based palliative care, according to a recent report from the New England Journal of Medicine Catalyst Insights Council.

Payment models play a role in addressing these questions in palliative care. For one, reimbursement structures tend to come with a regulatory framework, quality measures and a defined scope of service.

Currently, palliative care providers can find reimbursement through Medicare Part B for physician services, and also through supplemental benefits included in Medicare Advantage. Other reimbursement options exist in payment arrangements with Accountable Care Organizations (ACOs) and Managed Services Organizations (MSOs).

One emerging reimbursement trend is the Center for Medicare & Medicaid Innovation’s (CMMI) development of payment models that incorporate elements traditionally associated with palliative care, but without using those words. Examples include the Guiding an Improved Dementia Experience (GUIDE), the Kidney Care Choices and Enhancing Oncology models.

The GUIDE model, for example, includes language requiring “person-centered care meant to improve quality of life, delivered by interdisciplinary teams.” Thus, one could argue that palliative care principles are becoming more integrated into the larger system, even if stakeholders are not using the same terminology.

“We can talk about instances of disruptive palliative care models, but then we can also kind of zoom out and ask why palliative care emerged as a field in the first place. The answer is because there are a whole lot of gaps in usual care for very sick patients with complex needs,” Center to Advance Palliative Care CEO Brynn Bowman said at the conference. “We do see signs that those needs are being recognized and tried to be addressed in places all over the health system. The needs that palliative care intends to address are infiltrating into models and into how care gets paid for. It just hasn’t so much translated into a standardized model of specialty palliative care delivery for those patients who really need that level of service.”