Palliative Care at the Intersection of Value-Based Payment

Authored by Brent T. Feorene, Vice President, Integrative Delivery Models, Health Dimensions Group

Rapidly expanding value-based payment initiatives have presented providers with the ability to be rewarded financially for providing high-quality and cost-effective care, while imposing penalties on providers that do not meet performance thresholds.

Palliative care offers an unparalleled solution by enhancing the patient experience, improving population health, and reducing spending. A recent study revealed a 40 percent decrease in health care costs ($2,362 per day) when palliative care services are provided within the first 48 hours of a hospital admission.[i] The director of the Johns Hopkins Palliative Care Program indicated annual patient savings of $5,000 to $7,000 when palliative care is incorporated into a patient’s care program (2014).

It is important to distinguish palliative care from palliative medicine and hospice. Palliative medicine is specialized medical care for people with serious and advanced illness and is provided by a physician or advanced practice provider who specializes in this board-certified medical subspecialty. Palliative medicine becomes palliative care when an interdisciplinary team practices and delivers the care. While hospice focuses on care delivery at end of life and forgoes therapeutic patient interventions, palliative care is provided as appropriate and indicated throughout the disease trajectory of a patient—and patients can continue to receive curative treatments.

While hospice is a defined insurance benefit with clear payment streams, payment for palliative care is more varied and less defined, presenting both challenges and opportunities for providers.

Among health systems that have successfully integrated palliative care is Sharp HealthCare, a large health system based in San Diego. Sharp developed the Transitions Advanced Illness Management Program that uses risk assessments and algorithms to identify people at the very beginning of an illness that would benefit from palliative services. Results have been exceptional, highlighted by a 94 percent reduction in emergency department visits. Sharp’s program does well in a risk-based environment including Medicare Advantage plans, and, as an integrated system and owner of its continuum, Sharp realized a significant return on investment.

Post-acute and senior care providers are uniquely positioned to integrate palliative care within post-acute care delivered. Under the Bundled Payments for Care Improvement (BPCI) pilot, participants (skilled nursing facilities and home health agencies) developed care pathways that integrate palliative care as a means of quality improvement, enabling these providers to more effectively manage readmissions, length of stay, and potentially avoidable costs and services.

House call programs (HCPs) have also found tremendous value through integration with palliative care, and this growing strategy is evidenced by the palliative care HCPs offered by Jewish Senior Life, Southern Ohio Medical Center, and Northwell Health’s House Calls.

In this era of value-based care with payment increasingly tied to outcomes, payors and providers will be continually challenged to deliver high-value care. The integration of palliative care is not only imperative in this expanding value-based care environment, but also essential for person-centered, compassionate care.

To learn more or to request a copy of our white paper Palliative Care at the Intersection of Value-Based Payment, please contact Brent Feorene, Vice President, Integrative Delivery Models, at 440.871.2756 or

[i] Bharadwaj, P, et al J Palliat Med 2016 Mar; 19(3):255-8. doi: 10.1089/jpm.2015.0234


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