Palliative care has become a more sought-after treatment plan in recent years, and one agency in California has led the charge in advancing palliative care support among its population.
In September 2015, the Partnership HealthPlan of California — managed by Medicaid — launched a pilot program dedicated to palliative care, with an emphasis on enhancing patient outcomes while reducing costs associated with caring for chronically ill seniors. The pilot, called Partners in Palliative Care (PIPC), focused on streamlining processes for those receiving palliative care support at the end of life.
Dr. James Cotter, who has been with the Partnership HealthPlan of California since July 2014, clarified that the original pilot sought to determine if this type of program would be financially feasible for patients with two years of life expectancy or less.
“The program is funded strictly out of savings in hospitals’ utilization, so we needed to test that,” Cotter told Palliative Care News.
The pilot, which ran from September 2015 through February 2016, had 82 patients enrolled across four counties and palliative care organizations: Collabria Care, Interim Healthcare of Redding, ResolutionCare and YoloCares. Over the course of the six-month pilot, providers received a 95% patient satisfaction rate, while saving $3 in hospital bills for every $1 spent toward palliative care.
Cotter has been a board certified physician in family medicine since 1981 and worked as a hospice medical director from 1988 to 1989. He returned to hospice care part time from 2010 to 2014 from his home base in Napa County. Cotter describes the findings from the pilot program, and its subsequent influence, to showcase the vast importance of palliative care treatment.
“All of this started from a [University of California-San Francisco (USCF)] safety net study in 2010, which showed that most MediCal members spend a lot of time in the hospital close to death,” he said. “As a hospice physician, you want to give patients a soft landing.”
At that time, the state of California covered just four patient diagnoses for palliative care plans: cancer, end-stage liver disease, chronic obstructive pulmonary disease and congestive heart failure. Currently, the program covers 10 diagnostic categories, as a response to patients, hospitals and doctors alike. Those categories include:
- Congestive heart failure
- Pulmonary diseases, including chronic obstructive pulmonary disorder
- Progressive pulmonary diseases, such as cystic fibrosis
- Advanced cancers
- Advanced liver diseases
- Progressive degenerative neurological disorder, such as multiple sclerosis or Parkinson’s
- Hematologic disease
- Cerebrovascular accident
- Renal disease
- AIDS
By Cotter’s estimates, the program serves approximately 1% of the adults that are part of the Partnership HealthPlan of California. Currently, that aligns with between 500 to 600 patients at any given time, and up to 4,000 individuals could be eligible. Thus far in 2024, 625 patients have been active in the program; 1,000 were enrolled in 2023.
For individuals who take part in the program, they are required to be visited by a nurse and a social worker once each month. Most of the additional benefits of the program, an estimated 70% of participation, aligns with the social services offerings: transportation, housing and food.
The initial patient satisfaction rates have translated into longer-term satisfactory remarks because of that continued human touch, the diminished hospitalizations and personal palliative care, Cotter said.
“Patients were getting care in their own home, much more personal care and caregiver support — it was kind of like a mini hospice program,” Cotter shared, also noting the 24/7 phone support and a great deal of basic social services.
Today, the Partnership HealthPlan of California serves nearly 950,000 clients across 24 counties statewide. Cotter is grateful for this program’s ability to connect patients to the support they need at an earlier stage of their disease.
“Even still now, we can see a marked decrease in hospitalization within a month of being admitted to the program,” Cotter said. “That’s why the program is sustainable and financially successful … it’s not a money maker, but it’s a sustainable nonprofit health plan, and I’m very happy with how it’s worked out.”
Cotter recalls his own days as a hospice provider, and says he wishes this type of program was available then.
“This program has been something that allows us to have a bridge between just regular care in the doctor’s office and a hospice,” he said. “It’s such an essential program for those who need palliative care.”