Healthcare policy analysts have pointed to capitated managed care organizations (MCOs) or HMOs as excellent proving grounds for palliative care programs because of their payment structure and emphasis on coordinated care. As capitated systems, MCOs have the financial and organizational flexibility to integrate all elements of healthcare — from physicians to financing — into a coherent whole. As Lynn et al. note, "Advantages derived from managed care systems providing quality end-of-life care include coordinated care across delivery sites, interdisciplinary teams, integrated services, and opportunities to develop innovative care programs (1998:322)." In addition, MCOs provide a supportive environment for chronically ill patients, where care is coordinated from a proactive standpoint, anticipating problems, seeking them out, and addressing them before complications arise. Currently, about 6.5 million Medicare beneficiaries, or 16%, have enrolled in Medicare MCOs, typically under the Medicare+Choice program.
For all their advantages, MCOs must also wrestle with internal barriers to providing quality end-of-life and palliative care. Of paramount concern is the financial incentive inherent in capitated health plans to limit treatment and services. While this can work to the advantage of palliative care patients through an emphasis on quality over quantity by reducing medically inappropriate procedures, it can also be seen as a threat to quality by restricting access to necessary procedures (Lynn et. al, 1998). Clinicians must be ethically vigilant in seeking ways to balance the patient's wishes and interests with appropriate allocation of scarce resources.
For more information about the TriCentral Palliative Care Toolkit visit www.growthhouse.org/palliative/. All content is Copyright © 2002, 2003 by Richard D. Brumley, M.D. All rights reserved. No part of this toolkit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publishers. This guide to developing home-based outpatient palliative care services was developed through a grant to the Kaiser Permanente TriCentral Service Area from The Project on Death In America. The Kaiser Permanente TriCentral Palliative Care Program is a Sustaining Member of the Inter-Institutional Collaborating Network On End-of-life Care (IICN) which links major organizations internationally.
