The Many Benefits of Value-Based Palliative Care
Palliative care is undergoing a transformation in the United States. Often thought of as synonymous with end-of-life care, providers and payers are beginning to understand that palliative care holds numerous benefits for those living with serious illness. Consequently, this is leading to a rapid increase in both community-based palliative care and a recognition that palliative care is a strong contributor to value-based care delivery.
To understand this better, it’s important to appreciate palliative care as its own specialty: it is, in fact, specialized medical care for those living with severe illness and chronic disease. Palliative care can start at any point in a patient’s disease trajectory from the point of diagnosis until the end of life. The benefits of palliative treatment have been well documented over the years and include improved quality of life (“QOL”), decreased symptom burden and decrease in unnecessary healthcare costs at the end of life.
Palliative care and improved quality of life
Palliative care clinicians are trained to assess QOL using a variety of tools and use a multi-disciplinary approach to address these needs. QOL can be associated with many different factors: social isolation, spiritual distress, physical pain and caregiver stress, just to name a few.
Multiple studies have shown that palliative care can improve quality of life and relieve symptom burden in patients with chronic and advanced disease. This includes improvements in patient and caregiver satisfaction, benefits from additional social supports offered by palliative care, the essential domain of spiritual care that is offered by palliative care and improved physical well-being.
Quality of life and symptom burden
Symptom burden can be a significant barrier to good QOL in chronic disease patients. A recent review of the literature found that about 45% of cancer patients suffer from pain. Shortness of breath and chest pain in patients with heart disease can lead to increased anxiety and frequent visits to the emergency department, as can other chronic diseases such as chronic obstructive pulmonary disease.
Along with pain management goals, these difficulties can be addressed through palliative care interdisciplinary teams, who focus on educating patients and caregivers about disease trajectory and how to self-manage symptoms better with the goal of reducing unnecessary ER visits and hospitalizations.
This can even go beyond symptom management: a study from The New England Journal of Medicine (NEJM) in 2010 found that, for patients with metastatic non-small cell lung cancer, those who received early palliative care had a longer survival rate when compared to patients receiving standard care. The authors discussed that the increase in survival was likely due to better management of quality of life, symptoms and mood. This underscores the need for better symptom management and addressing social, physical and spiritual needs with patients.
Palliative care and decreasing unnecessary healthcare costs
Current healthcare spend on chronic disease management surpasses four trillion dollars, and estimates are that up to 25% of a person’s lifetime healthcare expenditures are in the last year of life. While not all of that expense is avoidable, there is no doubt that there is a need to reduce unnecessary healthcare expenses at the end of life.
Through careful advance care planning and discussions with patients and caregivers, palliative care has been shown to reduce unwanted hospitalizations, decrease intensive care unit deaths and reduce end-of-life care expenses all while improving QOL. These decisions are crucial to introduce early in a disease’s trajectory, at a time when patients are not in crisis; when they are resolved early on, the response to a medical crisis often better reflects a patient’s true wishes, which rarely involve costly and invasive medical tests and procedures, especially at the end of life.
This, in combination with a reduction of ER visits and hospitalizations for symptom management, means that patients enrolled in community-based palliative care programs spend more time where they want to be — at home, with their families.
The overall benefits of palliative care
Ultimately, these benefits of palliative care positively impact everyone involved in a patient’s well-being. For patients, palliative care improves quality of life and decreases symptom burden. Caregivers have greater support with proper engagement in end-of-life planning and decreased caregiver burden. Providers gain support with advance care planning discussions and better aligned treatment plans. And finally, payers see decreased healthcare spend, especially at the end of life.
All of these benefits are a result of palliative care’s core elements: comprehensive interdisciplinary teams collaborating around a patient’s goals and plan of care, consistent advance care planning and specialized training on symptom management and disease trajectory.
As we continue to see growth of value-based community palliative care programs, we also have an exciting opportunity to fully appreciate all the ways that palliative care can transform healthcare outcomes for the better for many patients with serious or chronic illness. The growing body of evidence in favor of leveraging palliative care as a standard approach to managing chronic disease will only be strengthened by these continued experiences, especially as the older population continues to grow exponentially. Are you prepared to adopt this strategy?