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Just what the patient ordered: In-home palliative care program

BY MARCUS THYGESON, M.D., Blue Shield of California, and
TERRY HILL, M.D., Hill Physicians Medical Group

National opinion polls have consistently shown when faced with a very serious illness, the majority of Americans would prefer to access care at home. However, the reality is that in the U.S. only about a third of such patients have received care at home.

Then there’s the question of palliative care, which is often misunderstood as being synonymous with hospice or end-of-life care. Palliative care is specialized medical care that focuses on providing relief from the symptoms and stress of a serious illness, and can include curative treatments such as chemotherapy. When individuals understand what palliative care provides, 97 percent say they would want to receive that kind of treatment.

So, now imagine delivering that kind of quality medical treatment at home to seriously ill patients, and adding social and emotional support for not only those members, but their family members and caregivers as well.

That is the goal of Blue Shield of California, Hill Physicians Medical Group and Snowline Hospice. The three organizations have come together to offer a unique home-based palliative care program to people living in Sacramento and El Dorado counties.

Within this new program, primary care physicians will offer palliative care services to patients with serious illness in collaboration with providers who are certified in hospice and palliative medicine. The program brings together an interdisciplinary team that includes a physician, nurse, social worker, home health aide and chaplain who visit the patient’s home. The patient would receive care that includes pain and symptom management, psychosocial support, advance care planning, grief counseling, disease management education, spiritual counseling, and other services as needed for patients and caregivers. In addition to this new service itself, Blue Shield and Hill Physicians are partnering to provide training and resources for advance care planning and palliative care to primary care providers and their staff so that patients and providers can make the best decisions possible when facing a diagnosis of a serious illness.

For Blue Shield and Hill Physicians, the in-home palliative care program is a natural next step because we already have been working together to provide case management and advance care planning support to our patients with serious illness. That collaboration included telephone support through Hill from nurses, social workers, pharmacists, and health coaches.

One of our earliest case-management collaborations involved a patient with COPD.  Because of his severe breathing problems, the patient was not able to enjoy one of his most precious quality-of-life goals, which was to go fishing.  While this pastime made him the happiest, he didn’t have a family member who could assist him.  So working together, our two organizations found a caregiving group that was able to arrange for someone to safely take the patient fishing. We later learned from his family how meaningful that had been to him.

This is just one example of our holistic approach to improving the quality of life and care for our patients. We expect the trend toward home-based palliative care to grow quickly in coming years.

By working together, we know we can help deliver care that is comprehensive and exactly what the patient ordered.

Marcus Thygeson, M.D., is senior vice president and chief health officer at Blue Shield of California

Terry Hill, M.D., is vice president of strategic performance at Hill Physicians Medical Group


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