Abstract
Home-based palliative care (HBPC)—originally developed for managed care—is an important model of care for patients with serious illness. Despite repeated studies demonstrating that HBPC can improve patient outcomes while decreasing costs of care, replication of this model in fee-for-service has been stymied by a lack of reimbursement structure. To overcome this barrier, a large California-based health insurer has begun to reimburse contracting medical group providers for HBPC. The purpose of this qualitative study was to explore the provider-level impact of implementing HBPC as a covered health benefit. Focus groups were conducted among interdisciplinary teams from community-based hospice organizations implementing HBPC. Participants consisted of registered nurses (40%), social workers (40%), and patient coordinators/liaisons (20%). Data were analyzed using Grounded Theory and results revealed three independent themes: 1) Referrals to the HBPC program; 2) Organizational factors; and 3) Reimbursement for HBPC. Findings highlight barriers and facilitators to implementing HBPC.