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Improving Access to Adult Home-Based Palliative Care Through Medicaid Expansion
Go III, James T. Lewis, Adam M. Miles, Rachel E. Radhakrishnan, Surya Santhanakrishnan, Shruthi Vejar, Anthony M.
Go III, James T.
Lewis, Adam M.
Miles, Rachel E.
Radhakrishnan, Surya
Santhanakrishnan, Shruthi
Vejar, Anthony M.
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Abstract
Background: Palliative care is associated with a more than fifty percent reduction in costs associated with end-of-life care. Currently 30% of Vermonters receive their healthcare through Vermont’s state Medicaid program. Despite this large proportion of Medicaid recipients, there is no Medicaid-funded home-based palliative care program in the state. The objective of this project is to better understand the need for home-based palliative care and assess the barriers to these services. Methods: A systematic literature review was conducted to develop a palliative care service package based on the models of Arizona, California, and Hawaii. Interviews with medical professionals and a focus group with representatives from multiple Home Health Agencies (HHAs) were conducted. The interviews and focus group were recorded and transcribed. Transcripts were reviewed by two separate coders in NVivo software, and the codes reconciled to unify qualitative themes and quotes. Results: From qualitative data, several core themes were extracted such as: benefits to healthcare, staffing and reimbursement, and education. Overall, benefits to providers and patients and educational gaps were among the most emphasized themes. Staffing and reimbursement were the primary concerns for HHAs for whom fee-for-service models may not be sufficient. Conclusion: Implementation of home-based palliative care services can benefit patients and healthcare providers by reducing hospitalizations and enhancing patient care. Delivery of these services remains challenging due to a variety of factors, including financial and staffing constraints from HHAs and educational gaps within the healthcare community. Medicaid expansion may help ensure effective palliative care delivery in Vermont.
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Date
2023-01-01