States can adopt a specific framework to help scale palliative care via Medicaid, according to a recent study published in Health Affairs.
Currently, the ability to scale palliative care nationally is limited by several obstacles. Among them are lack of awareness and workforce shortages. Another barrier is low reimbursement through Medicare that only covers physician and nurse practitioner services and does not pay for the full range of interdisciplinary care.
In the midst of this, some states have tried to improve palliative care access among their Medicaid populations in hopes of reducing unnecessary and expensive emergency room visits and hospital stays.
“Recognizing these challenges and federal inertia, states are increasingly implementing strategies to raise awareness, strengthen the palliative care workforce, and reform reimbursement to better support people living with serious illness …” the study authors wrote. “Over the past 15 years, states have increasingly adopted policies related to palliative care for people living with serious illness.”
As of 2024, nine states have implemented a comprehensive adult palliative care benefit, the study indicated. About 33 have established a serious illness task force to explore the issue, and eight states have established a pediatric palliative care benefit.
States can expand access further using a Engage, Design, Integrate, and Bundle (EDIB) methodology, the study authors contend.
This includes the following, according to the authors:
- Engage: To scale community-based palliative care, states must engage patients, families, providers, and health systems.
- Design: States should define palliative care elements including the core teams and services needed to support high-quality care for serious illness.
- Integration: States should assess the state landscape to identify mechanisms for integrating aspects of palliative care into existing contracts.
- Bundle: States should support specialty palliative care interdisciplinary teams through bundled reimbursement and standardized benefits across care settings.
States would also need to collect data on palliative care and quality measures.
“States can add language to managed care contracts to require data collection for palliative care-related quality measures, such as pain management and quality of life,” the authors wrote. “Other measures states may choose to incorporate include care manager skills training, care manager assessments, and referrals to palliative care.”
