Article | Partnerships and Value

Payer-provider partnerships focused on improving palliative care in California

Article | Partnerships and Value

Payer-provider partnerships focused on improving palliative care in California

California saw a spike in demand for palliative care services in 2014. Inpatient capacity met 33% to 50% of need, and community-based resources met just 24% to 37%. Payers and providers partnered to improve access to services at the right time and in the right setting, significantly improving capacity for services while reducing emergency department (ED) visits, leading to these improved outcomes:

  • Increased capacity of hospitals to meet 43% to 66% of the need for inpatient palliative care.
  • Increased capacity of community-based programs meet 33% to 51% of the need.
  • A decline in ED visits for one palliative care program dropped from an average of 57 visits to just seven over a three-month period.a

The initiative yielded many lessons for payer-provider collaboration, including the following:b

  • Finance team members and representatives from informatics, clinical areas and operations should participate in the idea-generation stage.
  • It is important to anticipate complexity, and create flexibility to modify agreements over time.
  • Consideration should be given to whether a member is truly a candidate for palliative care, not just on paper. For example, the member may be unwilling to engage with the palliative care team, or the member might have the social support needed to live safely at home.

a. Brookings, “Hospital productivity trends: Implications for Medicare payment policy,” June 25, 2019.

b. California Health Care Foundation, “Lessons learned from payer-provider partnerships for community-based palliative care,” Issue brief, October 2018.

About the Authors

Emad Rizk, MD

is chairman, president and CEO of Cotiviti, Atlanta (emad.rizk@cotiviti.com). 

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