AARP Eye Center
| Realizing that seriously ill patients often do better when they can stay in their own homes and receive coordinated and personalized treatment, growing numbers of health plans, physicians and medical facilities are offering pre-hospice, home-based palliative care to their patients.
Home-based plans typically integrate multidisciplinary care teams that include physicians and nurses, social workers, mental health professionals and chaplains who visit patients in their homes and offer tailored treatment plans focused on improving quality of life. The results can benefit patients and their caregivers and are cost-effective for the health care system, according to experts.
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Priority Health, which has nearly 800,000 members in Michigan, runs health benefit options for employer groups and individuals, including Medicare and Medicaid plans. About five years ago, Priority Health established the Tandem365 initiative, through which a multidisciplinary team provides free care to patients who are seriously ill and unable to seek outside medical help due to cost or immobility. The initiative has shown promising results, including:
- a 38 percent decrease in inpatient stays
- a 52 percent decrease in emergency department visits
- a 35 percent decrease in total cost of care
- 46 percent fewer specialty care visits
Palliative care combined with traditional care
“Most people lump palliative care in with hospice, but there are distinct differences between the two,” says Greg Gadbois, Priority Health's medical director. “With palliative care, curative care is also OK. The big goal is to have that discussion with the patient of: 'What is important to you? What do you want us to do, or what don’t you want us do?' Most say they want to be home with their family and in peace. Palliative is the low-tech, high-touch opportunity to learn what the patient wants and needs."
Having a home-based team also offers a new level of understanding for a patient’s situation, he says. “For doctors, they see a patient in their office for 20 minutes and don’t get a full picture. I‘m a family doctor, and when elderly patients come to see me, they are dressed in their Sunday best and will say that everything is fine. They want to impress their doctors. But in home settings, you can’t hide those issues and problems.”
Members of a palliative care team may see that the patient is in financial trouble and deciding between paying for medications or their heat bill. Or that the patient is a hoarder with a fall risk when walking through the house. These social determinants of health can provide important context to their overall health care plan, Gadbois says.
Palliative care also offers medical professionals the opportunity to discuss risks and benefits of traditional treatment plans, Gadbois says, noting that a study published in the New England Journal of Medicine showed that lung cancer patients who received early palliative care lived longer than those who didn’t. “It speaks to the fact that some treatment can be pretty toxic.”
Stereotypes remain that palliative care means giving up on extending life, but that perception is changing with increased use of the programs, Gadbois says. Retraining doctors to talk to their patients about end-of-life options is crucial. "We never received training on end-of-life discussions, and we are not comfortable talking about it. Death is seen as a failure. But the end is part of our journey. It is important to do a good job helping the person to transition from this world to the next with as much dignity as possible.”