“Access” was the watchword in the palliative care community during 2024, as providers sought more ways to reach the right patients at the right time.
However, the momentum toward greater access is slow, even though researchers, payers, providers and regulators increasingly recognized the value of palliative when it comes to improved quality and health care expenditures.
The following are the most-read Palliative Care News articles of 2024. This year’s top coverage spanned a wide range of payment, legislative and research trends impacting the future delivery of palliative care.
#1 What Palliative Care Providers Need to Know About Psychedelics, Cannabis
Palliative care providers need a wide lens when it comes to understanding the benefits and risks of utilizing controlled substances for therapeutic- and medically-guided patient experiences. But their plight to gain deeper insight is challenged by a complex web of evolving state and federal laws, as well as a lack of evidence-based clinical trial research, though momentum has been gaining to support future efforts.
Medical professionals have long explored the potential for certain controlled substances to help treat patients’ symptoms, particularly among individuals with serious and terminal illness. Substances in this realm include cannabis, ketamine, MDMA and psychedelics such as psilocybin and LSD, among others.
Much legal, ethical and logistical consideration goes into whether these drugs can be utilized for medicinal and symptom relief purposes, experts told Palliative Care News.
Laws vary across states, with some allowing for greater therapeutic use than others. Approximately 41 states have adopted some form of legislation permitting the use of “investigational drugs,” recent data shows. These “right to try” laws allow patients with terminal conditions to utilize these substances, mainly through clinical trials.
Research gained from these studies is instrumental in the ability to form future legislation, best practices, quality measures and efficacy, say palliative care providers.
Patients have increasingly sought alternative therapies that delve into the nonpharmacological realm. The trend came at a time when ketamine use has been growing as an avenue to assist with depression, mood disorders and anxiety, among other conditions. Alongside this has been mounting efforts to stem the tide of opioid abuse and addictions proliferating across the nation. Palliative professionals have increasingly sought alternatives to help manage patients’ pain and symptoms, including psychedelic- and cannabis-assisted therapies.
Clinical trial research in recent years has increasingly pointed to a range of benefits that patients have experienced with alternative therapy utilization Psychedelic- and cannabis-guided therapies have been found to alleviate post-traumatic stress disorder (PTSD), depression, grief symptoms, migraines, chronic pain and other medical conditions. But the data are just the tip of the iceberg of what’s needed to formulate future regulations.
#2 Key Palliative Care Trends to Watch in 2024
In the early days of the year, financial and operational headwinds were on palliative care providers’ radar nationwide. Operators in the space anticipated diverse challenges heading into 2024.
Topping the list of trends to watch in the last year was rising demand among swelling aging populations with chronic conditions, many of which lack the caregiving and family support to manage their symptoms in the home. This trend has helped community-based palliative care to earn greater recognition of its benefits.
A lingering barrier preventing wider access is a general lack of awareness around the nature of palliative care services, among the public and health care professionals alike. Though palliative care providers have long fought against common misconceptions, their strategies to reach referral sources have taken varied routes. These have included the development of more joint venture partnerships with other health care providers. Many providers have focused marketing efforts on reaching underserved patient populations.
Recognition has been growing when it comes to palliative care’s ability to help reduce hospitalizations and emergency department visits. Those services’ cost saving potential has gained palliative care providers traction in hospitals, health systems and primary care settings. More research has also tied these services to improved outcomes among patients and families and better care coordination.
The quality and cost benefits tied to palliative care delivery have been instrumental in value-based reimbursement. Providers have been carefully watching coverage trends in a patchwork of palliative care avenues spread across the Medicare and Medicaid payment landscape. The lion’s share of their services are reimbursed primarily through fee-for-service Medicare, which does not sufficiently cover the full breadth of interdisciplinary care.
Meanwhile, some industry advocates have called for the establishment of a dedicated palliative care benefit within Medicare, citing that the move would go a long way toward sustainable delivery during a tremendous time of need.
#3 Why Palliative Care Providers Are Adopting the GUIDE Model; CMS Launches GUIDE Model Demonstration With Strong Showing From Hospice, Palliative Care Participants
Tied at third are topics covering palliative care delivery trends for patients with Alzheimer’s and dementia-related conditions. Rising demand and unmet patient and caregiver needs have driven Medicare to seek to offer better support to those families.
An estimated 14 million individuals nationwide will have some type of dementia-related illness by 2060, more than double the 6.7 million Americans currently, according to the U.S. Centers for Medicare & Medicaid Services (CMS). The growth in this population was among the factors that drove the agency’s launch of the Guiding an Improved Dementia Experience (GUIDE) payment model forward last year, with ripple effects already trickling into 2024.
The GUIDE model is an eight-year payment demonstration that opened wider doors for palliative care reimbursement. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs. The GUIDE model features reimbursement for care coordination and management, respite services and caregiver education and support.
Nearly 400 health care organizations are developing Dementia Care Programs (DCPs), many of which provide palliative care.
The largest potential for palliative care growth in the GUIDE model centers around the potential for these services to address patients medical and nonmedical needs. Palliative care providers offer a variety of services designed to address social determinants of health and support caregivers with education and resources to assist with practical, financial and psychosocial needs. These services can be key to helping dementia patients receive goal-concordant care and navigating complex health care trajectories.
Palliative care services can also help reduce emergency department spending, which alleviates financial pressures and emotional distress for patients and families, studies have found.
The outcomes of the dementia care programs taking shape across the country will be among the key trends for palliative care providers to watch as the rest of the GUIDE model demonstration unfolds.
#4 New ASCO Guidelines Stress Importance of Early Palliative Care
The American Society of Clinical Oncology’s (ASCO) updated clinical practice guidelines in 2024 placed renewed emphasis on palliative care. The guidelines ignited conversations about the importance of these services at a time of significant advances among cancer treatments.
The new ASCO guidance highlighted palliative care delivery among cancer patients with greater acknowledgement around that these integrations can lead to improved quality of life and eased symptoms. The revised guidelines indicated a greater need to integrate palliative care services into oncology settings to foster greater access and support for patients and their families.
Evolving cancer treatments for patients such as immunotherapies and oral targeted therapies have changed their health trajectories. Many patients are unaware that they can receive palliative care alongside these curative treatments to help support a range of physical, emotional and spiritual needs. Access to palliative care has helped patients receive better care coordination and enhanced prognostic awareness, ASCO research found.
Patients lack access to palliative care in oncology settings, with the new ASCO guidelines elaborating on ways to integrate these services through earlier interventions. The guide has the potential to help foster stronger care collaborations for cancer patients with palliative needs.
#5 2 States Lead the Pack on Palliative Care Access, Many Lag Behind
Despite mounting research pointing to the benefits of palliative care delivery among seriously ill patients, these providers have long fought barriers preventing greater utilization of their services.
A recent report from the Center to Advance Palliative Care (CAPC) highlighted the current landscape of palliative care delivery across the country, with Massachusetts and Oregon leading the charge. These two states ranked at the top of CAPC’s America’s Readiness to Meet the Needs of People with Serious Illness Scorecard, which evaluates each state’s capacity to deliver high-quality care to people facing serious illness on a five-star scale.
Domains examined included access to specialty palliative care, payment for palliative care services, the structures and coalitions in place to advocate at the state level, clinical skills building and other kinds of state level resources for patients and caregivers.
The needle has much farther to go toward improved access among rural patient populations, the CAPC analysis found. Also, only 13 states currently require payment for palliative care services via Medicaid or other sources, suggesting that stronger reimbursement is needed for support access.
