Palliative care has been gaining steam as a crucial service over the last few years, but increasing its accessibility is largely dependent on figuring out how to pay for it. Without much in the way of reimbursements from federal payers, palliative care providers have traditionally been few and far between. However, some health systems are working on improving access and increasing awareness of these services within home settings, and harnessing data to prove the value.
UnityPoint Health (UPH), an integrated health system that operates in Iowa, Illinois and Wisconsin, has been improving its palliative care at home and hospice services across the health system for more than a decade. Since 2005, UPH has implemented metrics to measure the effectiveness of its growing reach with palliative care.
As the fourth largest non-denominational health system in the county, clinical executives hope their palliative care program successes can impact policy down the line for more reimbursement measures.
The UnityPoint at Home program has grown from 55 patients to more than 8,000 as of 2014.
While the program has been around for more than a decade, it started picking up steam and increasing its patient base once the data metrics were implemented. The metrics were based on research from what already existed nationally as well as additional information and definitions the health system considered, according to Lori Bishop, vice president of clinical services at UPH’s home division, UnityPoint at Home. UPH measures clinical, financial, operational and customer satisfaction metrics for palliative care across its inpatient, community and clinic settings.
“We’re an overnight sensation—if you think that it’s been 10 years in the making,” Bishop joked. “I do believe that we can see a direct correlation between the growth of our programs and the investment in these programs with our ability to measure.”
Once the health system integrated data across all settings, the value of palliative care gained firmer footing and the scope of the services expanded, according to Bishop.
“There’s a great uptick in the patients that we’ve been able able to serve that correlates with our ability to report out to our systems and to our regions the value of what we bring to the population for the seriously ill population,” Bishop said. “That growth started around 2011 and 2012 when we were able to start reporting out measures.”
Reaching more patients has had a big impact on hospital utilization and overall cost savings, by reducing readmissions by 50% for inpatient settings and 70% for outpatient settings between 2012 and 2015. UnityPoint measured six months before and after an initial consult, which mostly took place in an inpatient settings. The data revealed that there was a significant drop in hospital utilization following a consult.
Part of the success is also due to an increase in care coordination and referrals between home health care and hospice, according to Bishop. In the same three-year span, the percentage of palliative care patients referred to home health jumped from 4% to 30.7% following a discharge.
“There’s a relationship there that’s between that reduction in utilization of the hospital and the connection to those community-based providers,” Bishop said.
Metrics on a National Scale
Attributing the broad reach of UnityPoint’s palliative services to more data and refined metrics, Bishop is hopeful that this type of data can be brought to a national scale and eventually influence policy to expand palliative care services.
However, a real pathway toward policy that includes palliative care would likely result in increased regulation for these services that are similar to home care and hospice requirements, according to Bishop.
“There isn’t a lot of reimbursement for palliative care,” Bishop said. “We hope to improve that over time, but you also have to be careful what you wish for, because that would mean additional regulatory burdens for palliative care that don’t exist today. So, we have to be cautious.”
Expanding palliative care services nationally would also require an influx of health care workers to provide care.
“The biggest challenge is there aren’t enough palliative care-trained individuals to go around,” Bishop said. “Providers that are certified in palliative care and hospice are a hot commodity right now. There are not enough of them.”
Written by Amy Baxter