Recent years have brought evolutions in palliative care delivery that have helped improve sustainability, access and higher quality among the nation’s most vulnerable seriously ill patient populations.
This is according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). Esch, a palliative care physician, recently announced his departure after a 12-year tenure at CAPC. He will be stepping away from his role on Nov. 26.
Esch previously served as a senior education advisor and a consultant for CAPC, joining the organization in 2014. Prior to that, he was medical director of palliative care at Lee Health, holding a similar role at Haven Hospice.
Palliative Care News recently sat down with Esch to discuss the most significant changes taking place in the palliative care space.
How would you describe your tenure at CAPC?
My time at CAPC has been one of the most meaningful and rewarding chapters of my career. When I joined over a decade ago, I didn’t fully grasp how much I would learn, not just about program development or billing and coding, but [also] about leadership, collaboration and the extraordinary capacity of teams to make things better for people living with serious illness.
What stands out most are the people. The CAPC team is filled with some of the smartest, most creative and mission-driven individuals I’ve ever worked with. We have been able to build practical tools, training and frameworks that make palliative care more accessible and sustainable across the country.
It’s been a privilege to contribute to something that’s had real impact helping [palliative care] programs grow, helping clinicians feel more confident and ultimately helping patients and families receive the kind of care we’d all want for our own loved ones.
It’s also been a space that allowed me to stay connected to the “why” of the work, to remember that behind every dashboard [or] policy discussion is a real person trying to live as well as possible despite serious illness.
What is next on the horizon for you as you depart from your role?
It’s bittersweet, but the timing feels right. CAPC is in great hands and well-positioned for the next phase of its work. I’m ready to step closer to the bedside again. I’ll be spending more time in direct clinical care, something that’s always kept me grounded.
I’m excited to keep building things, whether that’s care models, teaching opportunities or new collaborations that make care more humane, more efficient and more sustainable. I’m looking forward to the next season being a mix of hands-on patient care and creative problem-solving.
In this [part] of my career, I’m going to be doing a couple different things. I always thought I would go back to my roots, which were in hospice care. I’m going to be doing more of that with Agape Care Group, doing regional medical direction for their hospice organizations in the Southeast. I’m also going to be continuing my work at the Moffitt Cancer Center in Tampa, Florida. At Moffitt, I’m doing an embedded palliative care clinic in their ambulatory oncology centers. So, it’ll be a mix of some hospice and palliative care work, which I’m really excited about being able to do both.
What are some of the most significant ways in which you’ve seen palliative care delivery evolve in recent years?
The field has matured in remarkable ways. When I started, palliative care was still fighting for its seat at the table; now, it’s recognized as essential.
We’ve moved from convincing people it’s important to figuring out how to deliver it well everywhere. Programs are increasingly embedded outside the hospital, with home- and clinic-based and virtual models growing fast. We’re also seeing much more sophistication in business planning, contracting and value measurement.
Another big shift is how interdisciplinary teams are being leveraged. We’re no longer designing programs around a single clinician. We’re designing ecosystems of care, physicians, nurses, social workers, chaplains and community partners all working together, often supported by technology.
I’ve seen an important change in mindset. Palliative care isn’t just for the last weeks of life, it’s about helping people live well throughout serious illness. That shift in language and timing has opened the door for innovation.
How do you foresee the future of palliative care taking shape?
I think the future is going to be hybrid, data-informed and at its core, human. Hybrid in the sense that care will increasingly cross settings [in the] hospital, home, clinic and in telehealth without losing continuity. Data-informed in that we’ll use artificial intelligence (AI), metrics, predictive analytics and digital tools to identify needs earlier and measure outcomes more effectively. And human because no matter how much technology we add, the essence of this field will always be relationships, communication and presence.
I also think we’ll see more cross-pollination palliative care principles embedded in nephrology, oncology, cardiology and primary care rather than existing as a stand-alone service. That’s a good thing. It means we’ve succeeded in influencing the culture of medicine.
Success will depend on payment models catching up. The programs that thrive will be those that can demonstrate value in clear terms, reduced hospitalizations, better patient experience, improved clinician satisfaction and then get paid accordingly. That’s why business literacy is becoming a core competency for palliative care leaders.
Can you expound upon your thoughts regarding the “cross pollination” of palliative care delivery?
Palliative care professionals spend a ton of time trying to prove their value and trying to prove that we deserve a seat at the table with other specialties. What I found recently is that I still go in with that mindset of needing to prove myself and I need to collect data to show that I’m making a difference.
One big cultural shift I’ve seen is that palliative care teams can improve retention rates. More [clinicians] are trained in a place where there has been palliative care. That’s a huge culture shift that is really good for the field. The culture shift makes up for whatever gaps there still might be, because they’re not just hearing from us that we’re important. They’re hearing from others that we work side by side with, that they want us and they view us as important, and that that has made our road easier in terms of expanding the reach of people that we can get to.
We’ve become part of the fabric of health care, and that feels really good in terms of the sustainability of it, which is always going to be a challenge.
Some of the advanced payment models also have helped. [The U.S. Centers for Medicare & Medicaid Services (CMS)] has done us a lot of favors in the last half dozen years. Some of the improvements in the billing and coding going to medical decision-making allows palliative care providers to get to pretty high codes pretty easily, just by the nature of the work we do.
Palliative care clinicians in general are getting more sophisticated with billing, using incident to billing or using social work billing where it’s applicable. Fee-for-service has also opened up possibilities for us. Some of the advanced payment models have opened up possibilities, and so the financial sustainability has become a lot more realistic to get towards budget neutrality.
What are the important considerations around technology integration in palliative care delivery?
I worry a little bit about AI-generated talking points going into a visit with a patient and a caregiver.
You have to ask open-ended questions, use some motivational interviewing skills and those are things that I don’t think AI is nuanced enough to really do well. It can be a guide, but I think open-ended questions and going to where the patient is ready to go is really the key.
What do you think is important to improving outcomes for seriously ill individuals and their families?
At its core, improving outcomes starts with listening — really listening — to what matters most to patients and families. From there, everything else flows: better alignment of treatment plans, fewer unwanted interventions and more coordinated care. But to make that happen consistently, we need four things:
- Access: Every person with serious illness should have access to skilled palliative care, regardless of diagnosis, geography or payer.
- Workforce and training: We need to invest in preparing clinicians, not just specialists, but also all clinicians, to have serious illness conversations, manage symptoms and coordinate across teams.
- Sustainable infrastructure: Programs can’t thrive on good will alone. They need stable funding, data systems and leadership support to deliver care at scale.
- I also believe we have to keep joy and purpose at the center. The work is hard, but it’s sacred work. If we take care of each other, the clinicians and the teams, we’ll ultimately take better care of patients and their caregivers.
