CQEL Meeting Focuses on Palliative Care Policy Efforts at the State Level

Moderator Emily Jaffe, MD, MBA (right) moderates a Q&A with Torrie Fields, MPH (upper left) and Jennifer Moore Ballentine, MA.

Research has shown that palliative care can benefit both patients and providers by better managing patients' symptoms and improving quality of life, reducing costs, reducing hospitalizations, and increasing hospice utilization at the end of life. Access to palliative care benefits, however, has been uneven, and dual-eligible patients who may benefit most from palliative care services often lack access. A number of states, though, are implementing distinct palliative care coverage for patients covered under Medicaid programs, with California leading the way. On June 28, the Coalition for Quality at the End of Life (CQEL) convened virtually to learn from Jennifer Moore Ballentine, MA, chief executive officer of the Coalition for Compassionate Care of California, and Torrie Fields, MPH, managing partner for TF Analytics, about how California designed its Medi-Cal palliative care program and the lessons other states have taken from the experience.

Ballentine presented an overview of the Medi-Cal palliative care program and how it is working since it was made law in 2018. Among the lessons learned are that legislation is only the beginning; implementation requires sustained support, trusted partners/conveners, and engagement. Provider education is essential, for both those referring for services and those delivering palliative care, and energy and resources must be invested in identifying and enrolling eligible members. Fields discussed the process of establishing a palliative care service benefit at the state level, including the potential policy routes that can be taken (e.g., waivers, legislation, state plan amendment, integration into existing programs). She highlighted the lessons from California's experience that are helping to ease the process for other states following in their footsteps.

Emily Jaffe, MD, MBA, vice president and executive medical director of Enterprise Palliative Care Strategy and Implementation at Highmark Health and Jewish Healthcare Foundation board member, moderated a question-and-answer session, in which panelists shared about the challenges of ensuring that palliative care expertise is available when access is mandated, the importance of establishing a palliative care task force early in the process, the need for a formal connection between academic–provider partnerships to ensure availability of a skilled workforce, and the value of identifying a champion who recognizes the benefits.

As a next step, the Jewish Healthcare Foundation end-of-life team will be convening a subcommittee of CQEL members to investigate whether and how a model for palliative care coverage and payment could work in Pennsylvania.