Frontline Provider Perceptions of Implementing Home-Based Palliative Care Covered by an Insurer

Alexis Coulourides Kogan
Oscar Li
Torrie Fields
Laura Mosqueda
Karl Lorenz
Peer-Reviewed Article
November 2021


Home-based palliative care providers explore key facilitators and barriers to effectively delivering care within a value-based payment environment.


Home-based palliative care programs have demonstrated improvements in patient outcomes and reduced costs of care. While financing challenges have limited growth for these programs within a fee-for-service environment, payers are increasingly contracting with providers such as accountable care organizations (ACOs) to deliver home-based palliative care as a part of a larger value-based strategy. This qualitative study examined provider experiences in implementing home-based palliative care covered by an insurer and delivered by community-based hospice and home health organizations participating in an ACO.


Providers identified barriers and facilitators to successful implementation of home-based palliative care. The patient referral process was challenging due to data issues such as reliance on administrative data, claims data, and algorithms to identify potential patients. Limited knowledge of palliative care among both patients and external providers was also a barrier, and at times led to patients being referred to the program before having an end-of-life conversation with the referring provider. Facilitators include having a “quarterback” for the program, strong team dynamics, and the payer’s per-member-per-month rate which gave teams flexibility to request and bill for durable medical equipment.


While the reimbursement challenges of home-based palliative care programs have been well-documented, this study examines specific facilitators and barriers to implementation when a payer contracts with ACOs to provide home-based palliative care. Providers implementing home-based palliative care programs must address patient recruitment and referral challenges.

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