March 22 Update: We updated the palliative care pilot providers chart at the end of this article to include:
- New information for UNC Health
- Information on a new provider - Lower Cape Fear Palliative Care
October 16 Update: We updated the palliative care pilot providers chart at the end of this article to include Mountain Valley Hospice and Palliative Care, servicing Alleghany, Davidson, Davie, Forsyth, Guilford, Iredell, Stokes, Surry, Wilkes, and Yadkin Counties. Thank you for sharing information about this program with your patients.
September 13 Update: We added a chart to highlight the differences between hospice and palliative care.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is partnering with four palliative care specialty providers to support an innovative pilot program. The program uses palliative care teams to coordinate care and provide an extra layer of support for your patients with advanced illnesses.
About the Program
- Palliative care specialty teams use an inter-disciplinary approach – delivering services to the right patient, in the right place, and at the right time.
- These physician-led palliative care teams:
- Include nurse practitioners, nurses, and sometimes a social worker and spiritual support.
- Meet the needs of both the patient and their caregivers, and provide care in the patient’s home.
- There is no copayment or cost share required of patients enrolled in the pilot program.
- We encourage you to refer your Blue Cross NC members with a serious illness to one of the palliative care pilot groups listed in the chart below.
Why palliative care?
Patients with a serious illness can decline as their disease progresses. Care can be fragmented, and may include costly interventions that don’t match the patient’s preferences. This causes undo stress, as well as frequent hospital admittances due to lack of home- and community-based care. High-quality, palliative care services can provide significant benefits for both patients and caregivers:
- The palliative care team does not take the place of the patient’s physician. Instead, the team coordinates care with the patient’s physician to provide additional support.
- The team listens to the patient to create a customized care plan that supports the patient and their family’s values. The plan is designed to help reduce pain and manage the patient’s illness-related symptoms.
- Provides guidance to the patient and their family, supporting them in understanding complex decisions. This helps reduce stress on both the patient and family, thus reducing the burden on caregivers.
- The team provides 24/7 access to the patient and their caregivers. The focus is on managing the symptoms associated with serious illness, and reducing the number of times the patient visits the emergency department, due to burdensome symptoms, or as a result of worsening health conditions.
- The palliative care team supports the patient’s providers by devoting time to intensive family meetings, and patient and family counseling.
How is palliative care different from hospice care?
While we often see hospice and palliative care paired together, there are several differences:
|Palliative Care||Hospice Care|
|Focus on patient’s comfort||x||x|
|Begins after the treatment of a serious illness stops and patient is nearing the end of their life||x|
|Begins at any stage of a serious illness||x|
|Can include prolonging and curative treatments||x|
|Promotes overall well-being, in addition to treating the illness||x|
Does the palliative care team take the place of the treating provider?
No. The palliative care team works closely with the patient’s primary care provider and/or specialist to coordinate care. The care team spends extra time with the patient to address issues and manage symptoms so treating providers can focus on managing the patient’s illness.
Who is eligible for palliative care?
The palliative care pilot program delivers community-based care to eligible patients with a diagnosis of a serious illness or multiple chronic conditions, including:
- Advanced COPD
- Heart disease
- Neurological disorders
- Kidney disease
- Liver disease
- Recurring pneumonia
- Other diseases which cause functional limitations
Individuals with Blue Cross NC commercial plans, including the State Health Plan, are eligible, with the exception of FEP members, and those with Medicare Advantage or Medicare Supplement plans.
How can providers identify patients who are appropriate for this program?
Please consider the following to determine if your patient is a good candidate for the palliative care pilot program:
- In the last six months, has your patient been to the emergency department more than once for:
- Weight loss
- Shortness of breath
- Does your patient’s serious illness impact their everyday activities?
- In the last six months, has your patient had more than one hospitalization?
What services are included in the palliative care pilot program?
Each individual enrolled in our palliative care pilot receives:
- A comprehensive, in-home, palliative care needs assessment
- A care plan that aligns with the patient’s goals
- Home-based palliative care visits, either in person or on the phone
- Medication management and reconciliation
- Psychosocial support for mental, emotional, social, and spiritual well-being
- Telephone support, available 24/7
- Support for caregivers
- Assistance with transitions across care settings, including admission to and discharge from any facility where the member seeks care
If you have a Blue Cross NC commercial member who is dealing with a serious illness, please refer the patient to the pilot provider in your area:
|Palliative Care Pilot Providers||Counties Served|
UNC Health (UNC patients only)
*Provides service within a 25-mile radius
Mountain Valley Hospice and Palliative Care
Lower Cape Fear Palliative Care
This article was originally published July 18, 2018.