In California, we need to begin creating and implementing standards for palliative care sooner rather than later, due in part to a new state law.
Palliative care is health care focused on relieving symptoms and stress for those with a serious illness. Unlike hospice, palliative care can go hand-in-hand with curative treatment.
A state law, SB 1004, approved by the California legislature in 2014, requires the state’s low-income health plan, Medi-Cal, to provide access to palliative care services.
With the passage of SB 1004, insurance companies, doctors and policymakers have started thinking about ways to standardize palliative care. The bill, which passed the California legislature with overwhelming and bipartisan support, focuses on providing palliative care to enrollees of Medi-Cal managed care plans, which serve more than 10.3 million Californians.
SB 1004 sparked a lot of conversation and concern: How would plans and providers work together to provide these services to patients? Where’s the standard to guide them on what counts as palliative care? How will providers be paid for these services?
This was one reason a group of us who are interested in the outcome convened as the California Advanced Illness Collaborative. Initiated and co-chaired by Marcus Thygeson, chief health officer of Blue Shield of California, and myself, CEO of the Coalition for Compassionate Care of California, we convened experts including health-care providers, insurers and researchers to form a planning group.
The long-term goal of this group is to make high quality palliative care available as a standard part of medical care for all Californians, not just those with Medi-Cal.
Our initial strategy is to define standards for palliative care in the community, and to pilot the standards.
Together, we have developed Community-Based Palliative Care Consensus Standards for California to help put a foundation in place. We have discussed who should be eligible for palliative care, how the care should be delivered, a payment structure and a way to measure the quality of the program.
Currently, standards for palliative care exist, but not for the delivery of community-based palliative care. Payers and providers are on their own to create, contract-by-contract, expectations, payments and agreements. Not only is this time-intensive and wasteful of the providers’ time, it’s nearly impossible for these providers to build internal systems or to scale their businesses. They become David in a battle against Goliath. Standards help level this playing field by giving each party a baseline agreement on the essential elements of a palliative care program.
Also, under the current system, patients suffer because they have no way of knowing whether health plans provide access to comparable palliative care services.
An important piece of our care standards include helping insurers and providers identify patients who would benefit from palliative care. In the Consensus Standards, we have laid out general qualifications along with disease-specific criteria as a starting point.
The standards we have laid out are a starting point, something for health-care providers and insurers to work off of to find common ground in creating and paying for a community-based palliative care program. They give both parties the benefits of predictability and stability, which in turn increases availability of palliative care to patients in need. By standardizing community-based care, patients can take full advantage of the benefits of palliative care—wherever they need it.
Judy Thomas is the CEO for the Coalition for Compassionate Care of California.