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Message from the California Health Care Foundation
The field of palliative care in California has made tremendous strides over the past three decades, and the California Health Care Foundation (CHCF) is proud to have contributed to this movement as a grantmaker and coalition builder for the past 15 years. When CHCF’s work in this space began, inpatient palliative care (PC) services were being established but were inconsistently available, outpatient palliative care clinics or home-based palliative care services were few, and payment for palliative care services relied heavily on health care system support, in-kind staffing, and philanthropic support.
Why Palliative Care?
Palliative care is a core part of high-quality, comprehensive care for people with serious illness and their families. The focus is on supporting patients and families and helping them navigate the challenges associated with serious illnesses, including these:
- Physical symptoms
- Emotional, social, and spiritual concerns
- Tailoring care to each person’s needs and values
A large body of evidence shows that palliative care enhances the experience and outcomes related to medical care for people with serious illness.
Due to the collaborative work of so many partners, the field looks very different today, with expanded access to palliative care across settings and expanded payment mechanisms through Medi-Cal managed care plans and other commercial or Medicare plans. Given this significant progress, CHCF has shifted its grantmaking away from palliative care. Still, we are aware this work is not complete, and this transition provides an opportune moment to both look back and celebrate the collective successes achieved by the many stakeholders responsible for the growth of palliative care, as well as seek input from the field on opportunities to build on and accelerate this growth to meet future needs.
For this project, CHCF collaborated with Transforming Care Partners, who engaged with and synthesized insights from in-depth interviews with over 30 leaders across five segments of the field (i.e., health plans, health systems / providers, community-based organizations, policymakers / government agencies, and membership organizations). Also, Transforming Care Partners facilitated a cross-discipline working session with over 200 participants at the Coalition for Compassionate Care of California Annual Summit in May 2023 to solicit more input.
This summary of progress and opportunities to further advance palliative care in the coming 5 to 10 years reflects the lessons from the analysis conducted by Transforming Care Partners as well as CHCF’s in-depth knowledge of activities related to those areas of progress and opportunities. The drivers of progress and opportunities for the future are intended to stimulate thought and to provide input into future strategic planning efforts and should not be considered comprehensive.
During the discussions that informed this work, many members of the palliative care movement remarked that the field of palliative care is at an inflection point in its growth. It is no longer in start-up mode, but it is not yet mature enough to be a universally accepted and integrated standard of care. These leaders stressed the importance of maintaining momentum at this critical point in the field’s development.
By looking at the key drivers of past successes and outlining examples of actions stakeholders can take to help accelerate future progress, CHCF and Transforming Care Partners aim to further conversations about how to help sustain the pace and set future priorities to continue the tremendous growth of palliative care in California for the next 15 years and beyond.
—Kate Meyers, Senior Program Officer,
California Health Care Foundation
About the Authors
This project and synthesis of findings were led by Loren Pogir, Founder and Managing Partner; Erich Bagen, Partner; and Meredith Lobel, Partner at Transforming Care Partners, a consulting firm focused on improving the experience of aging and serious illness care by partnering with leading and growing organizations on strategy development, implementation, and evaluation/learning.
Contributions to sections were also made by Kathleen Kerr, Partner, Transforming Care Partners and Monique Parrish, Director, LifeCourse Strategies.
Acknowledgments
First, the authors acknowledge and thank the people interviewed for this project (listed below), who generously shared their time, experiences, and insights. Those interviewed helped identify drivers of the significant progress made in palliative care in California, key opportunities to accelerate future progress, and stakeholder actions to advance these opportunities. The authors tried to recruit a broad range of people spanning multiple facets of the field but acknowledge that not every constituency is represented. It is hoped that the opportunities in this synthesis of findings spark future conversations where more voices can also be heard, and their input considered by the field.
Thanks also to the Coalition for Compassionate Care of California 2023 Annual Summit attendees who participated in the working general session “Building Our Future: Envisioning the Next Stage of Development for Palliative Care in California.” The considerable insights from those conversations have also informed this project.
Additionally, thanks to the following subject matter experts for providing guidance and input throughout this project, including advising on the approach to and scope of this project and providing feedback on the synthesis of findings: Kathleen Kerr, Partner, Transforming Care Partners; Anne Kinderman, MD, Clinical Professor of Medicine, UCSF; Kate O’Malley, RN, MS, Former Senior Program Officer, California Health Care Foundation; Monique Parrish, DrPH, MPH, LCSW, Director, LifeCourse Strategies; and Judy Thomas, JD, Strategic Advisor, Coalition for Compassionate Care of California.
Interviewees
Scott Bain, Former Principal Consultant, California Senate Committee on Health
Jennifer Moore Ballentine, MA, Chief Executive Officer, Coalition for Compassionate Care of California
Kim Beverly, MSW, MSG, Palliative Care Clinical Program Manager, Blue Shield of California
Teri Boughton, Policy Consultant, California Senate Committee on Health
Kimberly Bower, MD, Medical Director, Blue Shield of California
Brynn Bowman, MPA, Chief Executive Officer, Center to Advance Palliative Care; Assistant Professor, Brookdale Department of Geriatrics and Palliative Medicine, Ichan School of Medicine at Mount Sinai
James Cotter, MD, MPH, Associate Medical Director, Health Services Department, Partnership HealthPlan of California
Kelly Dearman, Executive Director, San Francisco Department of Disability and Aging Services
Susan DeMarois, Director, California Department of Aging
Anastasia Dodson, MPP, Deputy Director, California Department of Health Care Services
Jeanine Ellinwood, MD, Medical Director, Snowline
Susan Enguídanos, PhD, MPH, Associate Professor of Gerontology, University of Southern California
Wendy Fox-Grage, Senior Policy Fellow, National Academy for State Health Policy Aging and Disability Team
Matthew Gonzales, MD, Associate Vice President, Chief Medical and Operations Officer, Providence Institute for Human Caring
Cynthia Holzworth, RN, Director of Nursing-Outpatient Services, Hoffman Hospice & Palliative Care
Noelle Marie Javier, MD, Associate Professor, Geriatrics and Palliative Medicine, Mount Sinai Health System
Suzi K. Johnson, MPH, RN, Vice President, Sharp HospiceCare
Gary Lee, MD, Retired Internal Medicine Physician, Santa Clara Valley Medical Center
Blanca Martinez, MSW, CCM, Director of Case Management, Molina Healthcare
Diane Meier, MD, Founder, Director Emerita, and Strategic Medical Advisor, Center to Advance Palliative Care; Codirector, Patty and Jay Baker National Palliative Care Center; Professor, Department of Geriatrics and Palliative Medicine; Catherine Gaisman Professor of Medical Ethics, Icahn School of Medicine at Mount Sinai
Jill Mendlen, Founder and Chief Executive Officer, LightBridge Hospice and Palliative Care
Laura Miller, MD, Medical Consultant, Division of Quality and Population Health Management, California Department of Health Care Services
James Mittelberger, MD, MPH, Chief Medical Officer, Center for Elders’ Independence; Clinical Professor of Medicine, UCSF
Robert Moore, MD, MPH, Chief Medical Officer, Partnership HealthPlan of California
Steven Pantilat, MD, Chief, Division of Palliative Medicine; Kates-Burnard and Hellman Distinguished Professor in Palliative Care, UCSF
Cynthia Carter Perrilliat, MPA, Executive Director, AC Care Alliance
Susan Stone, MD, MPH, Senior Medical Director, L.A. Care Health Plan
Carin van Zyl, MD, Service Chief, Adult and Pediatric Palliative Medicine, Los Angeles General Medical Center
DeAnn Walters, Director of Clinical Affairs and Quality Improvement, California Association of Health Facilities
Susan Elizabeth Wang, MD, National Medical Director, Dignified Journeys and Palliative Care; Southern California Chief, Geriatrics and Palliative Medicine, Kaiser Permanente
