A Health Plan’s Approach to Providing Palliative Care 

Background: Today, millions of Americans live with serious illness. People living with serious illness can be young or old; they can live for many years after initial diagnosis or be near the end of life. Although people with serious illness are a diverse group, what they have in common is a high likelihood that they will require extensive care from their families or other caregivers.  

Program Goals: 

• Provide our members and their caregivers access to comprehensive community-based palliative care programs
• Provide care at the right time, in the right setting, and in accordance with our members wishes
• Create a robust, statewide network of community-based palliative care providers that is feasible, scalable, and replicable 

Methods: Blue Shield of California has built a statewide network of home-based palliative care providers through collaborative partnerships with provider groups and Accountable Care Organizations (ACO)/Provider Partnership Team, offering a broad network of home-based palliative care providers throughout the state.  

This evidence-based model of care features home visits from interdisciplinary teams that include physicians, nurses, social workers, chaplains, home health aides and other specialists to form a comprehensive care team and support system for patients facing serious illness. In addition, Blue Shield trained all internal clinical staff in serious illness communication skills and improved internal authorization processes to address urgency in authorizing necessary services for members with serious illness.  

As Blue Shield of California works to navigate the new scenery created by COVID-19, our teams are relying heavily on telemedicine (offered in all 58 counties in California) and enhanced communication between our teams. 

Results: 

• 40 California statewide contracted home-based palliative care providers (as of January 2020)
• Over 2,300 members served from program inception to January 2020 

Author: Kimberly Bower, MD, FAAHPM, Blue Shield of California and Promise Health Plan