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: patient referrals, organizational factors, and 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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