The Benefit of Palliative Care in the Home: A Value Based Approach

November 11, 2022

Studies and effectiveness reviews show that the involvement of palliative care can improve patient and family satisfaction and experience of care; reduce days in the hospital; reduce 30-day re-admissions; reduce emergency department visits; and, especially towards the end-of-life, reduce total spending.

By: Dr. Niraj Patel

Introduction: The importance of value-based palliative care

Studies and effectiveness reviews show that the involvement of palliative care can improve patient and family satisfaction and experience of care; reduce days in the hospital; reduce 30-day re-admissions; reduce emergency department visits; and, especially towards the end-of-life, reduce total spending. This means that increasing the involvement of palliative care can improve value-based performance in hospitals, home health agencies, skilled nursing facilities, dialysis centers, accountable care organizations, oncology care models, and bundled payment programs.  It is a known fact that integrating social determinants of health into a community-based palliative care improves patient outcomes and can help reduce higher-acuity care. The focus of palliative care is to optimize quality of life and mitigating suffering among people with serious, complex and often terminal illness. Delivering palliative care within the home is the optimal setting as it allows the interdisciplinary team (which includes physicians, nurses, occupational and physical therapists, social workers, chaplains, dieticians and other professionals) to create an integrated approach, working together to address symptom control. Furthermore, delivery of palliative care in the home setting allows the team to concurrently help address the non-medical needs that comprise of the SDOH such as nutrition, transportation, social or caregiver support. This holistic patient centered approach improves quality of life, resulting in both patient and family satisfaction while reducing the overall health cost as it allows the patients to remain in the comforts of their home in the lowest cost setting. According to the nonprofit economic research group Florida TaxWatch, home-based palliative care could reduce societal health care cost by $103 billion within the next 20 years.

Palliative care involves a multi-disciplinary approach. As a clinician that has had the privilege of serving patients in different settings within the healthcare continuum (both as an Emergency and Hospitalist based physician), the work that I do to help patients and families receive complex care, symptom management care, and end of life care has been most rewarding at this stage of my career. The opportunity to help patients with symptom management and end of life care is so personal. I have had the opportunity to understand the importance of palliative care, especially when delivered in the home setting to help prevent or decrease symptoms such as: acute and chronic pain, shortness of breath, and agitation before the patient progresses and requires hospital-based care. This was never more apparent for palliative home healthcare then during the COVID crisis, as many times families were not allowed to be with their loved ones in the hospital and SNF setting. The gratitude from both patients and families was limitless to healthcare providers such as myself, when we are able to deliver the care and help with pain and suffering. I will always cherish the positive impact during a scary and difficult time in many patients especially the elderly.

Defining Palliative Care Benefits

Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after an individual is diagnosed. In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.

To service palliative care in the home setting helps deliver positive patient outcomes through the ability to leverage care giver, family, friend, and neighbor support – especially for non-medical needs of a patient. Palliative care in the home is also beneficial due to the cost of care increasing in the hospital and other subacute settings. Furthermore, there is a continued healthcare provider staffing challenge that negatively impacts care delivery. Additionally, increased risk of nosocomial infections, adverse or iatrogenic events are greater when the patient receives care outside the home.

onehome’s Value-based and Multi-disciplinary Approach

The mission of onehome is to bring healing home with our multidisciplinary value-based care model, which includes both network and owned clinical providers. This value-based care model allows onehome to be in a unique position to positively impact health outcomes while preventing higher cost healthcare interventions (ex. hospitalization). Numerous studies have shown that patients and families want to have choices in care, and when deemed medically safe want to be in their own home environment, especially when dealing with an acute or chronic illness. onehome, through its value-based care model, in which onehome serves as both the care coordinator and convener, can serve and treat patients in the most comfortable and lowest cost environment, the home. By leveraging our technology, multidisciplinary care capabilities (home health, DME, Infusion, complex care programs) and people talent (nurses, therapists, NP’s and other providers) within our vertically integrated model onehome is able to deliver outcome driven care, while producing cost savings, positive healthcare results and satisfaction for all stakeholders. This very much aligns with the palliative care philosophy and approach.

onehome can either directly or indirectly play a role in how patients receive palliative care in the home setting. Through its networked and employed provider model, onehome can help support the palliative care philosophy, which involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. Patients and families want that continuum of the care in the home setting. onehome works with health systems, primary care physicians, hospitals and case managers to ensure patients are receiving high quality value-based care in the home setting. By leveraging these capabilities, onehome is able help facilitate or augment the care being received in the home setting. The onehome model not only provides value to members, but provides value to partnerships, as its strategy works to place clinicians and professional caregivers in roles that traditionally would have been directed by utilization management vendors. The onehome model executes: a single point of accountability; integration across core services; benefits management; and care delivery with employed clinicians. onehome serves many patients with various conditions, including those that are chronic. Understanding the importance of care at home, like that of palliative care, onehome provides comfort to patients who wish to heal at home, using cost-effective options. Applying the onehome model delivers both clinical outcomes and cost-effective care through the home health agencies, infusion pharmacy and DME operations.

The future of Palliative Care in the Home

According to the World Health Organization, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.  As the healthcare community and general society continues to embrace a more holistic and whole person care approach, (especially when those with serious illness) the growth and adoption of early palliative care intervention will continuing growing, and positively impact patient outcomes. With the increase in longevity and advancements in healthcare, patients are living longer often with chronic illness and serious disease. Patients and families want to age and now more then ever receive healthcare in the safety and comforts of their home with loved ones at their side. The philosophical and multidisciplinary approach of palliative care will only help with this patient and healthcare evolution and therefore the projected growth of Palliative care services is exponential with limiting factors being enough care providers (physicians, nurses, social workers etc.) to help direct and provide this care.

The U.S. palliative care market will reach $78.50 billion by 2023, a climb from $49.42 billion during 2018, according to a recent Market.us report. Palliative care adds to the patient continuum as a steppingstone, allowing continued curative care, while brining a high level of patient/family satisfaction. With the graying of our nation, increased disease burden, and a wanting to receive healthcare in the home, the growth of palliative care services to help augment the healthcare delivery is on a growth trajectory.

Palliative care is becoming a specialized medical care for people living with a serious illness, with the goal of improving  quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment. Our nation is truly at a crossroad where patients and families are rightfully demanding to be more involved in how their care is delivered and received. Palliative care providers and their service offerings are in a privileged position to help improve the patient and family experience while helping to bend the healthcare cost curve in America.

Biography:

Dr. Patel, Senior Vice President of Medical Affairs at onehome appreciates the benefits of both a multidisciplinary and integrative medical model, where symptom management with holistic whole person care is ever more important, specifically in the elderly and highly vulnerable patient populations. Drawing on his years of both acute, post-acute and home health care medicine, Dr. Patel understands the impact (both positive and negative) that social detriments of health can have on patient health outcomes, cost, and overall quality of life.  Dr. Patel has obtained board certification from American Board of Internal Medicine (ABIM), Post-Acute Long-Term Care Certification (CMD), Hospice Medical Director Certification (HMDC), and Healthcare Quality Management Certification (CHCQM) with a special interest in transitional concurrent and coordination of care, quality focused initiatives, the impacts of disease burden on high-risk patients, improving the patient and family experience, population health, and reducing healthcare cost.

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