Potential is mounting for deeper integration of palliative care delivery across the continuum, with some health care settings better poised than others for evolving opportunities.
Palliative providers need more avenues to reach seriously ill patients with unmet physical, emotional and psychosocial needs, particularly those in rural areas across the country, said Shelby Moore, executive director of Heartlinks. The Washington-based provider offers adult and pediatric hospice, palliative care, grief support and senior living services.
Among the growing opportunities is the possibility for greater palliative care reach into outpatient oncology settings, according to Moore. While palliative-oncology models have more commonly seen growth in urban areas, rural and frontier regions remain vastly underresourced, leaving a wide range of underserved populations, she said.
“[A] growing opportunity is the integration of palliative care into outpatient oncology clinics,” Moore told Palliative Care News in an email. “There is significant potential to expand it into rural settings, ensuring that more patients receive palliative support earlier in their treatment journey. There is also an increasing recognition of the importance of integrating palliative care at an earlier stage in a patient’s disease process, which could lead to better overall outcomes.”
Primary care integration
Palliative care providers have a wider landscape of potential reach aside from oncology settings.
Palliative care is largely misunderstood among the public and other health care providers, which often results in late referrals and disparities in access, according to Dr. Martha Twaddle, The Waud Family Medical Directorship’s palliative medicine and supportive care clinical professor of medicine at Northwestern Medicine. The Chicago-based health system offers palliative and primary care, among other services.
Palliative care providers have long-fought the battle for improved awareness and stronger referral streams, seeking out partnerships with providers in various settings, Twaddle said. More seriously ill patients who may benefit from palliative care well-before goals-of-care conversations are on the horizon, she added.
More primary care providers are recognizing the need for deeper integration of palliative care services, seeing benefits such as cost-savings potential and improved outcomes, Twaddle indicated.
“We sometimes see patients way too late to make a difference and change the trajectory of suffering, so it’s about the further we can move this care upstream,” Twaddle told Palliative Care News. “My dream is to see it really fully integrated into the primary care model so that two things happen. One is that primary care practices learn how to risk-stratify their patient populations to identify and anticipate the needs of this group and scale up palliative support for them. And two, is continuing to do the care management and coordination in the home, which the integration of embedding a palliative care model into primary care would work well in.”
Expanded telehealth ‘invaluable’
One of the greatest opportunities in palliative care today is leveraging telehealth to improve access, Moore said. Temporary telehealth waivers instilled during the pandemic have proven to be an “invaluable” tool in delivery quality palliative care, particularly for those who struggle with transportation or mobility due to illness, she added.
Though the future of telehealth regulations remains uncertain, this remote avenue of health services holds “enormous potential,” for palliative care providers to improve access while also alleviating caregiver burden, according to Moore.
Expanded telehealth utilization has been a key to addressing some of the biggest challenges facing palliative care delivery — a lack of sufficient workforce resources, Moore said. The issue has been particularly difficult for rural communities with limited options.
Proposed restrictions on prescribing controlled substances via telehealth could further limit the effectiveness of palliative care programs, Moore stated. Additionally, the shortage of trained palliative care providers continues to be a major issue, making it difficult to offer services earlier in the disease process, she added.
Evolving technology innovations in health care delivery are among the most significant trends shaping the palliative care landscape, according to Brynn Bowman, CEO of the Center to Advance Palliative Care (CAPC).
Rising demand for community-based palliative care is pushing more technology-enabled pathways to the forefront, expanding the reach of these services to more patients and families in the process, Bowman indicated.
The technology trends are coming at a time when new billing opportunities for palliative care teams have increasingly emerged in recent years, she added. More reimbursement has come to fruition that provides funding for caregiver education and navigation, and allows for more time to be spent with high-complexity patients, according to Bowman.
Additionally, coverage around other services for which palliative care teams previously had no reimbursement opportunities under traditional Medicare have widened, Bowman stated. These include the Guiding an Improved Dementia Experience (GUIDE) payment model. The model is designed to improve support for patients with Alzheimer’s and dementia-related conditions, including stronger caregiver programs – an area in which palliative programs are well-versed, Bowman said.
“Several trends are shaping the trajectory of palliative care right now,” Bowman told Palliative Care News in an email. “Technology-enabled care, including not just telehealth, but also AI applications in areas like symptom management and predictive analytics. Demand for home-based care continues to rise, not just among payers, but also among patients and families. The needs of caregivers in general are increasingly being recognized at the advocacy, policy, and payment levels, bringing some new resources to bear. And the palliative care field is taking impressive action toward more equitable health care for people with serious illness, and their caregivers.”
