The steadily growing elderly population shows health-care providers and insurers alike that they need to put emphasis on a different kind of care -- palliative, or comfort care. And many of the bigger insurers have taken notice to this increased need.

By 2020, the number of U.S. citizens aged 65 and older will have increased 44 percent, to 55 million people, according to the U.S. Census Bureau.  Aetna, Blue Cross Blue Shield of Minnesota and Blue Shield of California have all started to expand coverage for palliative care. In fact, BS of California has already implemented patient-centered management (PCM) as a way to control cost and improve quality of care for the company’s most critically ill beneficiaries. PCM involves end-of-life care, pain management, patient education and patient advocacy -- all typical elements of palliative care.

How Health Plans Are Striving To Meet New Needs

BS of California enlisted the aid of Paradigm Health, an independent organization that provides palliative care to more than 150,000 patients nationwide. Paradigm provides PCM by educating patients and their families about their pain and medical conditions, enabling patients to make better choices about the treatments they seek, and preventing them from bouncing in and out of the emergency department, which can be costly for insurers and provide little help for them.

BCBS of Minnesota has also expanded coverage for palliative care and wants to raise awareness about comfort care’s importance among its members and provider networks, says David E. Pautz, MD, FACP, the health plan’s medical director. “Our aim as a health plan is to identify members earlier in their journey of a progressive, debilitating illness and assist them in getting those services to help maintain their quality of life even as their physical health may be declining,” he explains.           

Much like BS of California, BCBS of Minnesota doesn’t focus on only the physical aspects of end-of-life care. “There are also nonphysical areas of suffering that also need to be addressed,” says Pautz. “These include cultural, psychological, social, spiritual, religious, existential, ethical and legal issues. So the kinds of services and treatments covered are those necessary to address those issues.”

Aetna began its “Compassionate Care Program” in 2005. According to Susan Millerick of Aetna’s business communications, the program includes: “a public Web site; case managers who are specifically trained in end-of-life care issues, including palliative-care issues, whom all members can access; and a benefits package that is specific to the Compassionate Care Program,” she says. “Members can seek both curative and palliative care treatments (or specifically, hospice care) at the same time -- which effectively removes a significant barrier to hospice and the palliative care services they provide.”

Much like BCBS of Minnesota and BS of California, Aetna’s program focuses on PCM as a way to provide members with the highest-quality care possible.

The Need Will Continue To Grow

 “The number of medical centers offering palliative care has nearly doubled since 2000,” according to an article in USA Today. And that’s not surprising, considering the number of elderly Americans that will need comfort care as they continue to age and fall ill. Pautz hopes that more providers and insurers will put more emphasis on palliative care and services and notes that as a culture, Americans don’t plan for debilitating illness or death as much as they should.

“There has been too little emphasis on symptom relief and advance care planning. Promotion of palliative care will raise the awareness and prompt change,” Pautz says. He also hopes that providers will initiate conversations about palliative-care options with their patients early on.

Aetna also sees the documented proof of the need for palliative-care coverage. “We are focusing on increased use of hospice, average number of days spent in a hospice program (in- or out-patient), and the percent of members on pain medication prior to their death,” Millerick says, noting that effective pain and symptom management are key elements of palliative care.

As palliative-care coverage becomes more of a necessity than a desire, insurers and providers alike will all need to plan accordingly to meet the aging population’s needs.

And although health plans can actually save more money than it will cost to expand coverage for palliative care and PCM, Millerick points out that it’s not only about costs.

“We launched this program and continue it today because we believe it is the right thing to do,” she says.