In essence, community palliative care is simply identifying “the right care, at the right time, for the right patient,” says Dr. Janet Bull, chief medical officer at Four Seasons Compassion for Life.
The approach hardly seems radical, but it’s the basis of the potentially game-changing health care model that won the local nonprofit hospice and palliative care provider a $9,596,123 grant award in May from the Center for Medicare and Medicaid Innovation, a program of the federal Department of Health and Human Services. The grant will allow Four Seasons to implement health care reform over a three-year period, with the aim of delivering better care outcomes and lower costs. The nonprofit is based in Flat Rock, and serves Buncombe, Haywood, Henderson, Jackson, Macon, Transylvania and Swain counties, with offices in Flat Rock, Highlands and Asheville.
Palliative care is a specialized form of medical care, delivered by a team of professionals that may include social workers, chaplains, nurse practitioners and physicians who treat people with advanced, serious illnesses, explains Bull. This type of care is often appropriate for hospice and terminally ill patients but is also used for patients who are working toward a cure. “It’s what we call patient- and family-centered [care],” she says, “because a lot of what we do is really understand what’s important to patients and families and try to align their treatment with their choices [and] help them navigate the complexity of the medical world.”
The grant is one of 12 awarded this year and the only grant awarded in palliative care. It will allow Four Seasons, in conjunction with its collaborative partner, Palliative Care Center and Hospice of Catawba Valley, to follow 8,000 Medicare beneficiaries and their families over three years, track outcomes and study cost data and quality. Clinical and financial results of the project will be monitored through a partnership with Duke University. The findings will translate into potential finance models to assist Medicare beneficiaries, as well as national benchmarks for other palliative care organizations to improve patient outcomes. The grant will also allow Four Seasons to provide more professional training and create educational videos as well as implement a telehealth program. All these initiatives are intended to further increase patient access to care and information.
The biggest difference between the palliative care model and other models of care is that palliative care is team-based, says Bull. That team-based, community-centered model ensures that the patients’ care doesn’t end when they walk out of the hospital. “There’s a huge problem when people leave the hospital,” says Bull. “Sometimes discharge orders aren’t understood, sometimes patients don’t get back to follow-ups with their doctors, they might not get the right medications, they might not be able to afford their medication, and so there’s not a lot of continuity of care. Part of what we propose in following very sick people is to be part of that system of continuity. … We make sure that we are identifying the medical issues that [patients] have but also the psycho-social issues, things like spiritual distress or depression, social isolation, those kinds of factors that often drive getting people readmitted to the hospital.”
Four Seasons also connects patients with outside community resources as appropriate. For instance, if a patient doesn’t have the resources to get enough food or someone to fix meals, a social worker at Four Seasons might connect him with Meals on Wheels or a similar agency.
Bull says that most palliative care programs in the country are limited to the hospital setting because “no one has really figured out how to financially deliver this kind of care in the home setting because there’s not much reimbursement for it.” But over the last decade, Four Seasons has not only been able to grow its program, but the nonprofit partnered with Duke University Medical Center in 2005 to study and report on quality measures. The research has shown that Four Seasons’ community care model delivers higher-quality outcomes. With the shift away from the pay-for-service model toward the pay-for-performance model currently happening in health care, as well as eliminating unnecessary procedures, the palliative care model also lowers costs for both the federal government and families.
“The aim [of the palliative care model] is not necessarily to save money,” Bull is quick to point out. “It’s a byproduct of giving people the kind of care they want, and I think we have to be really careful because it’s not at all about rationing, which I think the media sometimes plays upon, but it’s really not. It’s about giving high-quality care.”
In a lot of instances, says Bull, lack of communication leads to unwanted, costly medical procedures that put strain on both the patient and the patient’s family. “What a lot of the studies have shown us is that, for instance, most people, when they get to the end of their lives, prefer to die at home,” says Bull. “They don’t want to go back to the hospital. Yet they often haven’t had that conversation with their physician or their care team, so they can get stuck in this system where they are having a lot more medical intervention that may not necessarily help them to get any better.” By giving patients the care they want and need, saving money is a welcome side effect.
Learn more about Four Seasons Compassion for Life at fourseasonscfl.org.