Cost, Satisfaction, and Policy Effects of a Pediatric Palliative Care Program
California implemented a Section 1115 Medicaid waiver pilot called Partners for Children (PFC) from 2010-2012 to provide concurrent palliative and curative care to children with life-threatening conditions in home and community settings through enhanced care coordination and service provision. We analyzed PFC’s effect on health care costs and family and provider satisfaction.
Paid claims and administrative data of PFC enrollees were analyzed to calculate cost impact. Surveys with enrollees’ primary caregivers measured satisfaction and PFC’s impact on family experience. Surveys with care coordinators, hospice/home health agencies and physicians assessed provider satisfaction and engagement.
Over the three-year pilot, 132 children enrolled in the program for at least 60 days. Mean health care costs per enrollee per month (PEPM) were reduced by $3,331, driven by a $4,897 PEPM decrease in inpatient care costs. Families exhibited satisfaction with PFC and believed program services helped reduce or control their child’s pain and other symptoms, as well as their own trouble sleeping and level of worry. Providers expressed satisfaction with the program but visibility was a problem among prospective referring physicians, two-thirds of whom were not familiar with PFC.
California’s concurrent care demonstration yielded major cost savings by enhancing care coordination and home-based services to avoid preventable hospitalizations. The ability to remain at home and confidently rely on program services improved children’s and families’ experiences. PFC has achieved program status but must broaden its reach by improving visibility among providers who serve as enrollment channels for families confronting a child’s life-threatening illnesses.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Public health administration or related administration
Public health or related public policy
Public health or related research
Describe California's pediatric palliative care waiver program Evaluate the cost effect of providing care to children with special health care needs in home and community settings Evaluate caregiver and health care provider satisfaction with California's pediatric palliative care waiver program Assess the policy implications of California's pediatric palliative care waiver program
Keyword(s): Children With Special Needs, Health Care Delivery
Qualified on the content I am responsible for because: I was one of the evaluators of California's pediatric palliative care waiver program and wrote the official evaluation report. I have experience researching multiple programs related to provision of care and benefits for children with special health care needs and their families, and have written and presented on these programs.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.