ElderBranch Takes an In-Depth Look at Two Leading Palliative Care Programs

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Kaiser Permanente and Sutter Health are pushing the envelope when it comes to palliative care. ElderBranch spoke to Dr. Susan Enguidanos and Betsy Gornet to learn more about each program and understand how they are paving the way to higher quality care for patients near the end of life.

ElderBranch recently released the third and fourth parts in its four-part series on end-of-life care – End-of-Life Care III: Kaiser In-Home Palliative Care Program and End-of-Life Care IV: Sutter Health’s AIM® Program. Parts III and IV take an in-depth look at the Kaiser Permanente and Sutter Health palliative care programs through interviews with individuals intimately involved in each program’s design and roll-out.

The Kaiser Permanente program was jointly developed with the Partners in Care Foundation, a research institute focused on testing and disseminating evidence-based models of care. The program evolved as a result of recognizing that there aren’t existing mechanisms to address the decline that chronically and terminally ill patients start to experience much earlier than what is typically referred to as ‘end of life’. “Our whole health care system is designed to cure and provide care for people who are healthy and can navigate the system, but we don’t have anything that provides the other needs that people have as they start to decline and experience serious health problems,” says Susan Enguidanos.

The Kaiser program is largely modeled after hospice care, with a multidisciplinary team involved in each participant’s care. The program is open to those with a life expectancy of up to one year and doesn’t preclude participants from continuing to pursue curative care. In-home physician visits and on-demand access to medical personnel are two elements that contribute significantly to the success of the program. While the program has been very successful to date, Dr. Enguidanos firmly believes that reforming the current largely fee-for-service payment model is critical to supporting the roll-out more broadly, across populations, geographies and systems outside of Kaiser Permanente.

The Sutter Health AIM® program arose out of a desire to better match care and services with the goals of those living with advanced illness. Betsy Gornet remarked, “What is lacking is the ongoing conversation between a health care provider and a person living with chronic illness regarding life goals, care options, care choices, and other important quality-of-life decisions. These things evolve over time and, frequently, health care providers only have intermittent methods of discovering what their patients are thinking and feeling.”

Sutter Health’s AIM program relies on an interdisciplinary team to bridge the gaps found in the system, from collaborative planning and sharing of information between providers, to focusing on the patient’s particular wishes and goals when it comes to care. Ongoing awareness by the care team of each patient’s goals, care choices and quality-of-life decisions are the keys to the program’s success. When it comes to the broader roll-out of programs such as AIM, Ms. Gornet raises a number of challenges. These include, but are not limited to, differences across populations in terms of provider contractual arrangements, payment mechanisms, levels of physician engagement and competing provider goals and priorities.

While there are several challenges and barriers to adoption, programs such as these are required to establish firm proof-of-concept and push for meaningful change in the area of advanced illness management and end-of-life care.

About ElderBranch
ElderBranch is an online information portal that helps people find and evaluate long-term care providers. ElderBranch’s mission is to support users in making the best decision possible for themselves and their loved ones. ElderBranch currently offers a comprehensive, national database of nursing homes and useful articles and tools to help users navigate senior care issues and decisions.

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Anila Sitaram Venkat
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