Although research shows that patients benefit from palliative care earlier in the course of serious illness, it is not always accessible to them. Among the factors affecting access is health insurer reimbursement, since most benefits for palliative services are patterned on the Medicare Hospice Benefit, which is limited to patients with a prognosis of six months or less and prohibits reimbursement for curative care once patients choose palliative-focused care.

Some of California’s health plans, however, are developing palliative care benefits for earlier access to services. This landscape report describes the findings of research on payers working to increase access to care. Among the initiatives:

• Enhanced case management. Aetna, Health Net, and United Healthcare have programs to provide intensive contact between specially trained case managers and patients with advanced illness.
• Liberalized hospice benefit. Aetna, Anthem Blue Cross, Health Net, and United Healthcare have benefits (for non-Medicare Advantage patients) that expand the prognosis criteria for hospice admission and/or enable concurrent reimbursement for both curative and palliative services.
• Home-based palliative care. Kaiser Permanente–Southern California offers home-based palliative care to all members.

Other payers are piloting similar and additional initiatives to provide palliative services earlier to their members.

The complete report is available as a Document Download.