Prioritizing holistic palliative care for improved outcomes in employer health plans
Comprehensive palliative care can improve healthcare outcomes for those living with a serious illness while lowering costs for patients and health plans. Integrating this specialized care into employer health plans is a step toward a more compassionate and affordable care experience for millions of Americans.
At least 12 million adults and nearly 400,000 children in the United States are currently living with a serious illness and could benefit from palliative care, according to the Center to Advance Palliative Care .
For health plans, providing palliative care presents an opportunity to improve patient outcomes while reducing the cost of care. With the baby boomer generation continuing to age, a holistic and patient-centered approach to palliative care is one of the best ways to help health plans manage rising costs.
Understanding palliative care
Palliative care is specialized medical care that addresses the physical, emotional, nutritional, spiritual, and social needs of a patient living with a serious illness or chronic condition, and their loved ones.
While often confused with hospice care, there is an important distinction between the two.
Hospice care provides medical comfort and support for:
- People with a serious illness whom doctors determine have six months or less to live.
- People who agree to stop or not seek treatment to cure or control their illness. Often, people choose hospice when medical care fails to cure or slow their disease. They can, however, continue to receive care to manage their pain and discomfort.
Palliative care provides coordinated medical support and comprehensive treatment for:
- People who are living with a serious illness, such as congestive heart failure, chronic obstructive pulmonary disease (COPD), cancer, dementia, or Parkinson’s disease.
- People of any age and at any stage of their illness.
- People who can or want to continue treatment aimed at curing their illness.
How does a serious illness affect patients and families?
Patients living with a serious illness may experience severe and worsening symptoms like pain, nausea, and shortness of breath. The care they receive may conflict with their goals, values, or preferences. They often experience unnecessary or unwanted hospitalizations, skilled nursing facility stays, and emergency room visits. Plus, with any serious illness comes complex emotional and mental health issues, including anxiety, fear, depression, and grief.
In addition, patients' families and caregivers are often affected. According to a report by the National Alliance for Caregiving and the American Association of Retired Persons (AARP) :
- 21% of Americans provide unpaid care for an adult with health or functional needs.
- 31% of family caregivers have difficulty coordinating care.
- 23% of Americans say caregiving has made their health worse.
How palliative care makes a difference
For these patients and those who care for them, palliative care offers better support.
A well-designed palliative care program takes a whole-health approach that addresses the physical, emotional, and behavioral needs of patients, their families, and their caregivers. A specialized care team of doctors, nurses, and social workers closely coordinates care, providing:
- Disease and symptom management, including better pain control.
- Coordinated in-home care and support services.
- Communication with family members and other caregivers.
- 24/7 support either virtually or over the phone.
- Advance care planning and support for end-of-life treatment decisions, if needed.
This can help patients and health plans realize improved health outcomes, better quality of life, and lower healthcare costs.
Improved healthcare outcomes
The comprehensive nature of palliative care promotes adherence to treatment plans and medicine for better disease management and long-term health outcomes. A data-driven and personalized plan for palliative care improves patients' health status by:
- Controlling or alleviating symptoms that affect quality of life and disability.
- Reducing treatment intensity; the need for intensive, costly treatments and interventions; and invasive treatments for advanced disease.
- Improving coordination between providers, resulting in fewer errors and enhanced efficiency in care delivery.
Better quality of life
Because palliative care integrates behavioral care as well as support for caregivers, it can help with:
- Reducing patient and caregiver anxiety, depression, and substance use disorders.
- Improving patient satisfaction.
- Aligning with patient goals, values, and preferences.
Lower healthcare costs
Through preventive and ongoing disease management, palliative care helps manage costs by reducing:
- Hospital admissions and readmissions.
- Emergency room visits.
- Intensive care unit (ICU) utilization.
Providing compassionate and affordable care
At Carelon, we provide comprehensive and cost-saving Palliative Care. Our care teams are led by board-certified doctors and can also include a care coordinator, nurse, nurse practitioner, and social worker. Our clinicians are available 24/7 to support patients with symptom management, patient–family communication, advance care planning, medical crisis prevention, and urgent response.
For health plans, ensuring that employers can offer employees access to a data-driven, robust, and comprehensive palliative care program not only benefits those who are suffering from a serious illness or complex condition, but can also make sense financially. Palliative Care is a cost-effective way to provide compassionate care to patients as well as those who care for them.
