The Kaiser Permanente (KP) TriCentral Palliative Care Program, an interdisciplinary home-based program that blends palliative and curative care, offers patients at the end of life enhanced pain control, symptom management, and psychosocial support. It was developed for patients with congestive heart failure, chronic obstructive pulmonary disease, and cancer in response to KP internal data indicating that 63 percent of patients in intensive care units and 54 percent of other hospitalized patients with these diagnoses died. The program currently provides a gradual transition for patients with a 12-month survival prognosis, allowing them to maintain their primary care physician while receiving home visits from a palliative care team. The program has met goals for pain control, receives high patient satisfaction scores, and in an initial study was found to have reduced costs by 45 percent. The program is developing web-based resources for its replication; expansion to other KP sites is planned.
Rochester Health Commission (RHC), created in 1996, is a nonprofit, community-based organization dedicated to improving the quality, access, and cost of health care in the community. RHC was identified by the RAND Corporation as one of three model health care coalitions in the United States. Comprised of key stakeholders, the commission has equal provider, consumer, and business representation on its board. Currently, RHC has 12 communitywide initiatives under its umbrella, including those addressing patient safety, communitywide clinical guidelines, and end-of-life/palliative care. Communitywide clinical guidelines were developed for asthma, diabetes, depression, congestive heart failure, pain, and other conditions. The end-of-life/palliative care initiative focuses on improving pain management for all types of pain in all care settings, from doctors’ offices to nursing homes and hospices. RHC received a Robert Wood Johnson Rewarding Results grant for its work linking communitywide guidelines to incentives, and has long been involved in performance measurement, dating back to Health Plan Employer Data and Information Set (HEDIS)® reporting in 1999. RHC also developed the Rochester Model, a broad-based chronic disease proposal that focuses on restructuring the area’s health care system to properly align incentives and provider/consumer/employer efforts to improve health care.