•Describe the role of trained lay persons in delivering palliative care.•Identify the key outcomes that result from early introduction of palliative care. Beginning in 2012, a large Minnesota healthcare system designed a late life supportive care model to address the question: Will whole-person support for patients with serious illness and their families result in better quality-of-life and care experience, and will it improve utilization and access to palliative care and hospice? The intervention (LifeCourse) is an in-home approach, structured on the domains and recommended practices of palliative care. LifeCourse is delivered primarily by trained lay persons (care guides) supported by a clinical team. It is directed to persons with heart disease, cancer, and dementia who are living with serious illness and may be in the last 3 years of life. About 1200 individuals, including participants, family members, and comparison patients and families, are enrolled to date. All are surveyed quarterly. We will describe the hiring, training, and workflows that allow care guides to address National Quality Forum-identified best practices. We will describe their role in recognizing issues upstream, communicating goals of care, and empowering patients and families to find solutions to their needs. Early results of the intervention were analyzed using a mixed methods study, comparing LifeCourse to usual care. For LifeCourse patients and families, several aspects of quality of life and care experience fared better than for comparison patients and families. Hospital days in the last 6 months of life were lower for LifeCourse patients, and emergency department visits were significantly reduced. LifeCourse patients were more likely to be referred to inpatient palliative care and hospice, and they spent about twice as many days under hospice care. Total cost of care data was available from a subset of patients. These individuals were statistically matched to similar-spending controls and followed over time. Overall spending was lower for the LifeCourse patients. This intervention shows promise in extending the reach of palliative care.