Showing up: meta-spatial palliative care at home with Telehealth
An electrified conversation is rising in our society about how we will care for each other as life approaches completion. Rather than collectively continuing to avert our gaze, we are turning our attention directly at the truth of our mortality and beginning to address the human, social, and economic impact of our fragmented and disease-directed healthcare system. The recent 2014 Institute of Medicine report, Dying in America, is a wholesale call-to-action for more and better care for people approaching death. Too often we provide inadequate support for quality of life, generate a distressing patient experience, and low value: high cost healthcare that can exploit people with serious illness rather than serve them. In rural America, this is magnified by primary and specialty provider shortages, the burden of travel for patients, and inadequacies in basic skills of symptom control and reality-based communication about the truth of aging and the limitations of medical technology. The cost is avoidable suffering, loss of trust, provider burnout, and a mountain of wasted money. As the approaching wave of aging Americans brings the impact of their demographics, they also bring a new sensibility and empowerment to decision-making. They want guidance, not guidelines.
The medical specialty of Palliative Care brings person-centered care to people with serious illness by attention to exquisite symptom control, effective communication and planning, and shared decision-making with a disciplined focus on the quality of life defined by that person and their family. This teamwork is interdisciplinary, time intensive, and poorly compensated in the fee-for-service system. Palliative care is also powerfully effective at improving the quality of life and satisfaction for people with serious illness, and saves huge amounts of money by delivering value rather than simply more billable services. As this set of attractive features gains traction with policy makers, professional organizations, and the public at-large the demand has already swelled to four times the capacity of currently trained palliative care providers.
We see this as an opportunity. ResolutionCare is a community-based person-centered palliative care program that innovatively uses ubiquitous videoconferencing technology and an extraordinary team to both increase capacity and extend our reach in rural Northern California. In addition, we are innovating through developing partnerships with payers to transform payment models that deliver value to people on their own terms, and in their own homes. ResolutionCare avoids the infrastructure costs of a freestanding ambulatory clinic setting by seeing people only in their homes via house calls or “virtual” house calls using cloud based videoconferencing technology with modest bandwidth requirements. By sharing risk and a portion of the cost-savings with payers, we are able to sustainably support a nimble team to deliver value to people with serious illness with the services that they define as needed to support their quality of life. ResolutionCare Fund is an educational initiative dedicated to using the same scarce resource of a interdisciplinary palliative care team, and the same videoconferencing technology to train provider teams in a variety of practice settings where people with serious illness receive care.