Engaging Primary Care Physicians: Lessons Learned Seeking Buy-In and Patient Referrals for a Home-Based Palliative Care Program (TH341D)

Abstract

•Describe the factors that may impede primary care physician buy-in and patient referrals for a home-based palliative care program.•Discuss the lessons-learned and possible facilitators to better engaging primary care physicians in a home-based palliative care program and initiating patient referrals. Home-based palliative care (HBPC) is an important model originally developed for managed care. It surpasses the continuity and access barriers plaguing inpatient palliative care by providing palliative care in patients’ homes in collaboration with primary care. Repeated studies have demonstrated that HBPC can improve patient outcomes while decreasing costs of care, however, replication of this model in fee-for-service has been stymied by a lack of reimbursement structure. To overcome this barrier, a large California-based health insurer (Blue Shield of California) has begun to reimburse contracting medical group providers for HBPC. However, over 12-months later, primary care physician (PCP) engagement and patient referrals for the HBPC program are dismal. The purpose of this secondary mixed-methods study was to explore the impact of PCP outreach efforts by a physician champion for the HBPC program. PCPs were identified as practicing in the Sacramento, CA region and having a greater percentage of Blue Shield patients in their practice. The physician champion contacted PCPs to arrange one-hour in-person meetings to discuss the HBPC program. Bi-weekly field notes from the 12-month study period were analyzed using the constant comparison method. From June 2017-2018, 18 solo practitioners (66.7%) and clinicians at 9 group practices (33.3%) were contacted by the physician champion (average contacts=3). On average, practice sizes were 1,108 patients (±1,050.5; range 210-5,639) with 33% (±7.4%; range 23%-54%) comprising Blue Shield patients. Qualitative findings revealed four themes: overburdened PCPs; fear of losing patient control; facing mortality; and dilemma for mid-level providers (managing patient care in light of PCP oversight). Findings highlight the specific challenges to engaging PCPs and obtaining their buy-in for a HBPC program and a set of implementation strategies have been developed.