Partnership HealthPlan of California, a health insurer covering roughly 200,000 Medi-Cal beneficiaries in six Northern California counties, has decided to offer the optional benefit of palliative care to its members.
"It's part of health care, and part of life," said Richard Fleming, the regional medical director for PHP. "That's why we're arranging for greater availability of palliative care. It's an enhanced benefit, for people before they're in hospice."
People in palliative care are severely ill, but don't fall specifically into the definition of being within six months of dying. "They need a lot more medication management, and there are social issues they need help with," Fleming said.
The state doesn't currently offer the enhanced benefit, in part due to budget concerns, but Fleming said the cost of palliative care is offset by less necessity to provide other types of care that may not actually benefit the patient or the family, he said.
"We did a cost analysis. We're a health plan, we wanted to see what the cost would be," Fleming said. "It's not going to save a lot of money, it's probably about cost-neutral. But the quality-of-life issue is significantly better. We think it's going to be an important quality-of-care issue."
Fleming said the palliative care benefit should be available "within the next couple of months," and PHP is starting the training of clinical and administrative staff now. He expects data on the program's progress in six months to a year, and hopes a successful model would mean adoption by other plans.
"We would hope so," he said. "We're very willing to share our experience with other health plans."
PHP serves Medi-Cal patients in Solano, Yolo, Napa, Sonoma, Marin and Mendocino counties, and expects to expand into Lake County by June 2013, Fleming said.
"I hope it's something people can talk about more," he said. "It's an important part of health care. We want our staff to become more comfortable personally, to interact with our members about it. It's not a frequent topic, but it does come up occasionally."