Alexis Coulourides Kogan1, Oscar Li1, Torrie Fields2,3, Laura Mosqueda1, Karl Lorenz4. 1. Keck School of Medicine of USC, Department of Family Medicine and Geriatrics, University of Southern California, Alhambra, California, USA. 2. Healthcare Quality & Affordability, Palliative Care, Blue Shield of California, San Francisco, California, USA. 3. VotiveHealth, San Luis Obispo, California, USA. 4. Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
Abstract
OBJECTIVE: To examine frontline providers' experiences implementing home-based palliative care (HBPC) covered by a private health insurer in partnership with community-based hospice, home health, and Accountable Care Organizations. STUDY SETTING: Primary data collection at three community-based hospice and home health organizations in Northern and Southern California at the outset of the new private payer-contracted HBPC. STUDY DESIGN: Qualitative focus groups with frontline HBPC providers. DATA COLLECTION: Focus groups were guided by a nine-item, semi-structured research protocol, audio-recorded, transcribed verbatim, and analyzed by two independent coders using a grounded theory approach. PRINCIPAL FINDINGS: Participants (n = 24) were mostly White (79.2%) female (91.7%) aged 39 years or less (62.5%), and from diverse disciplines. Three major themes were identified: (1) patient referrals, (2) organizational factors, and (3) HBPC reimbursement. Findings highlight barriers and facilitators to implementing HBPC covered by an insurer including the organization's community reputation, the dynamic/"teaminess" of the HBPC team, having a site champion/"quarterback," and issues from a siloed medical system. Participants also discussed challenges with patient referrals, specifically, lack of palliative care knowledge (both providers and patients/families) and poor communication with patients referred to HBPC. CONCLUSIONS: This study found that despite a favorable perception of payer-contracted HBPC by frontline providers, barriers and facilitators persist, with patient accrual/referral paramount.
OBJECTIVE: To examine frontline providers' experiences implementing home-based palliative care (HBPC) covered by a private health insurer in partnership with community-based hospice, home health, and Accountable Care Organizations. STUDY SETTING: Primary data collection at three community-based hospice and home health organizations in Northern and Southern California at the outset of the new private payer-contracted HBPC. STUDY DESIGN: Qualitative focus groups with frontline HBPC providers. DATA COLLECTION: Focus groups were guided by a nine-item, semi-structured research protocol, audio-recorded, transcribed verbatim, and analyzed by two independent coders using a grounded theory approach. PRINCIPAL FINDINGS: Participants (n = 24) were mostly White (79.2%) female (91.7%) aged 39 years or less (62.5%), and from diverse disciplines. Three major themes were identified: (1) patient referrals, (2) organizational factors, and (3) HBPC reimbursement. Findings highlight barriers and facilitators to implementing HBPC covered by an insurer including the organization's community reputation, the dynamic/"teaminess" of the HBPC team, having a site champion/"quarterback," and issues from a siloed medical system. Participants also discussed challenges with patient referrals, specifically, lack of palliative care knowledge (both providers and patients/families) and poor communication with patients referred to HBPC. CONCLUSIONS: This study found that despite a favorable perception of payer-contracted HBPC by frontline providers, barriers and facilitators persist, with patient accrual/referral paramount.
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