Palliative Care Definitions and Delivery Models

What is palliative care?

Palliative care is specialized medical care for people with serious illness. It focuses on providing patients with relief from the symptoms, pain and stress of a serious illness – whatever the diagnosis.

The goal is to improve quality of life for both the patient and the family. It is appropriate at any age and at any stage of a serious illness. It can be provided at the same time as disease treatment to help people live as well as possible while facing illness.

Why is palliative care important?

The need to improve the quality and reduce the costs of care has never been more urgent. Approximately 90 million Americans are living with serious illnesses such as cancer, heart disease, frailty, functional dependency, and/or dementia. This number is expected to more than double over the next twenty-five years as the baby boomer generation reaches old age.

Studies show that most people living with a serious illness experience inadequately treated pain and other symptoms, fragmented care, poor communication with their doctors, reliance on 911 calls and hospitals to manage chronic illnesses, and enormous strains on their family caregivers.

Providing better care of the sickest and costliest 10 percent of our patients – those driving more than two-thirds of all health care spending – is the key to achieving genuinely high quality health care and ensuring the financial viability of our health systems.

Palliative care has demonstrated in multiple studies that it can achieve the win-win health care scenario: higher quality care at lower cost. By improving care and preventing crises for those at highest risk, palliative care reduces the need for burdensome and costly acute care services.

Many payers have worked to bring palliative care to their members, and have seen excellent returns on that effort.

For more details on the essential clinical skills and structural components for an effective palliative care program, you can download the full toolkit here. The characteristics identified in the toolkit can guide payers’ provider training and recognition initiatives, support the evaluation of new care management programs and inform the design of benefits offered to members.

Palliative Care Skills for All Frontline Clinicians 

Frontline clinicians (non-specialists)

*At diagnosis, patients need initial discussions about the benefits and drawbacks of treatment options and what to expect in the future, as well as preliminary advance care planning.

 

*Patients need pain and symptom management while they pursue disease-directed treatment to maximize function, independence and quality of life for as long as possible.

 

*All providers who care for patients with serious illness should have the skills to provide this type of care. Earlier use of palliative care ensures better quality of care and minimizes the need for crisis care.

 

 

 

 

 

 

Palliative care specialists

 

*The progression of illness often results in the increased need for expert or specialist-level palliative care.

 

*Specialist-level palliative care is delivered at the same time as disease treatment, by a palliative care team working alongside a patient’s regular doctors.

 

*A typical palliative care interdisciplinary team is composed of a physician, an advanced practice nurse, a social worker and a chaplain, all specialists in palliative care.

 

 

Palliative Care Delivery Models across Settings

 

 

 

 

 

 

 

 

 

Hospital palliative care

 

* Currently the dominant delivery model, hospital palliative care teams either provide consultation to the attending physician or assume primary oversight of care, depending on the preferences of the referring physician.

 

* In the consultation model, the palliative care team does not assume primary responsibility for the patient and family, but instead provides an added layer of support to address their needs in addition to their ongoing disease-specific treatment.

 

* The palliative care team is often called upon to treat intractable pain and symptoms, communicate with patients, families and other treating providers in order to match treatment options with the patient’s goals of care, or to help create care plans that enable safe discharge and minimize the risk of readmission.

 

 

 

 

 

 

 

Community-based palliative care

 

* Palliative care may be provided in the patient’s home, an assisted living facility, or an outpatient clinic such as a physician’s office, dialysis unit or cancer center.

 

* Community-based palliative care models include, for example, advanced illness management (AIM) programs, supportive care programs embedded in cancer centers, and “post-acute” transitional care programs.

 

* These care models are developing rapidly in an effort to meet the needs of the sickest and costliest patients – who must otherwise resort to 911 calls, emergency department visits, and hospitalizations for problems that could and should have been addressed safely and effectively in the community.

 

 

 

 

 

Hospice

 

* Hospice care is a well-known and comprehensive delivery model of palliative care, but it is limited to terminally ill patients.

 

* The Medicare hospice benefit defines hospice eligibility as appropriate for patients when two doctors certify a prognosis of six months to live if the disease follows its usual course, and the patient agrees to forgo Medicare coverage for disease modifying treatment.

 

Member organizations can access CAPC tools, training and technical assistance through our courses, or through a variety of webinars, virtual office hours, topic-specific discussion forums and more. To log in, click here. To become a member organization, click here.