Frontline provider perceptions of implementing home-based palliative care covered by an insurer

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.

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.

Qualitative focus groups with frontline HBPC providers.

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.

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: (1) patient referrals, (2) organizational factors, and (3) 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.

This study found that despite a favorable perception of payer-contracted HBPC by frontline providers, barriers and facilitators persist, with patient accrual/referral paramount.