A range of emerging payment model demonstrations are integrating principles traditionally associated with “palliative care” into their structures, but without using that term.
The Center for Medicare & Medicaid Innovation’s (CMMI) has unveiled a series of models that incorporate elements designed to provide patient-centered care to improve seriously ill patients’ quality of life. 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.
Bringing this approach to a broader range of care models and clinical specialties can only benefit patients and help ensure that they receive better care, along with reducing costs. This is a good thing, but I would argue that the health care system and its patients would benefit if CMMI called this approach what it is, to state clearly that these models involve palliative care.
One might ask, “What’s the difference?” as long as patients are getting the care. And that argument has merit. Access to this type of care is the most important concern. But I would counter that question with a few points.
For one, palliative care providers for decades have been operating by those principles — patient-centered interdisciplinary care designed to support quality of life. For the larger health care system, this is a relatively new approach.
Clearly defining this concept as “palliative care,” would show providers participating in these models where they can go to learn how to integrate these concepts. It could help them understand who they should be partnering with, what research they should be doing and where they can get further education on how to implement this in their care models. They don’t necessarily have to re-invent the wheel.
Specifying the term “palliative care” within these models can also help drive a better understanding among clinicians and provider organizations of what those services are. A plethora of common misconceptions, such as conflating palliative care with hospice, is a major barrier to patient access. By fostering awareness via payment models, CMMI could accelerate positive change.
Identifying these approaches as palliative care could also help define that specialty more effectively. Lacking a standardized definition, some providers, even those who are well-intentioned, can play fast and loose with their care models. A patient receiving palliative care from one provider may be getting a totally different set of services than one cared for by a different organization.
Because after all, payment models are about more than billing codes and writing checks. Reimbursement structures tend to come with a regulatory framework, quality measures and a defined scope of service. This could help sharpen and formalize what this kind of patient-centered interdisciplinary care should look like.
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 focused on the diverse range of patient needs. Let’s help stakeholders understand and recognize this potential. Call it what it is.
