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Study: Insurers Are Palliative Care Innovators

Six major health insurers in California are expanding access to palliative care by providing more specialized case management and opening up the hospice benefit beyond its Medicare boundaries, according to a new study expected to be released today.

The study, “A Better Benefit: Health Plans Try New Approaches to End-of-Life Care,” is accompanied by a second paper in today’s scheduled release: “End-of-Life Care in California: You Don’t Always Get What You Want.” The two papers are funded and published by the California HealthCare Foundation, which publishes California Healthline.

The study of the six largest health plans was based on interviews with stakeholders and with health plan directors, as well as reviews of published studies and academic reports, to determine the extent of palliative care alternatives at those plans.

“The biggest surprise was I was surprised by how much they are doing,” said report co-author Merry Davis, a consultant for Touchstone Consulting. “It turns out this is a real sweet spot for them.”

Davis said research points to better results when palliative care is offered earlier. “It improves quality, it improves outcomes and it lowers cost — the triple aim [of health reform]. It also improves patient satisfaction, and family satisfaction, as well.”

When the Affordable Care Act was first launched, one of the demonstration projects centered on innovations and improvements in palliative care, Davis said. “But unfortunately, it was made to be sort of a political hotspot. That was the whole ‘death panel’ thing and it was one of two federal demos not funded.”

Innovations now are occurring in private-pay insurance, Davis said.

“They’re doing more and more care provision, more enhanced case management and I think they’ll be getting more involved, especially in California,” Davis said, because this state has instituted more managed care than other states.

“As the risks become shared, and with more managed care, plans will be partnering more with providers and figuring how to keep costs down.

Leading the way in palliative care in California is Kaiser, Davis said. “There are more things going on than you think,” she said. “And I think there’s going to be a lot of movement in this area, as medical homes and accountable care organizations develop, as providers come together and share risk, it will become more important.”

At the national level, though, the palliative care innovations adopted by Aetna blazed a path that other insurers have followed, Davis said. “That really jump-started the industry,” she said.

California HealthCare Foundation scheduled a briefing on the two reports May 8 in Sacramento.

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