The Evolution of At-Home Care

SUMMARY Arundhati Parmar speaks with Jill Schwartz-Chevlin, Chief Medical Officer at Vinca, about the evolution of palliative care from a hospital-based, end-of-life service to a community and home-based model for patients living with serious illness. Jill explains how Vinca grew from an advanced care planning platform into a value-based palliative care company serving patients across five states, primarily through Medicaid and Medicare Advantage plans. The conversation covers the critical distinction between palliative care and hospice, the cost savings data that health plans are paying attention to, and what it will take for Medicare to finally build a sustainable reimbursement model for the specialty. KEY TAKEAWAYS Palliative care is not hospice. It is symptom management and whole-person support for patients still pursuing active treatment for serious illness, including cancer, COPD, and advanced heart failure. More than 75% of hospitals now have palliative care teams, but their positioning around end-of-life discussions has created a widespread misconception that palliative care equals dying. Home-based palliative care through Vinca produces a 42% reduction in ER admissions and a 53% reduction in hospitalizations. Only three states (California, Hawaii, and New Jersey) have established a Medicaid benefit specifically for palliative care. Traditional Medicare offers no such benefit. The current fee-for-service model for palliative care is not sustainable. Most palliative care programs linked to hospices survive only because the hospice subsidizes them. KEYWORDS palliative care at home, home-based palliative care, serious illness management, palliative care vs hospice, Vinca health, value-based palliative care, Medicaid palliative care benefit, Medicare Advantage palliative care, community palliative care, advanced care planning, hospice length of stay, ER reduction palliative care, whole-person care, serious illness, home health palliative care, CMO interview healthcare, palliative care reimbursement, MedCity Pivot podcast Links and resources  Connect with Arundhati Parmar  [email protected]  Arundhati Parmar (@aparmarbb) on X MedCity News EPISODE HIGHLIGHTS [00:02:04 – 00:02:36]  Jill defines palliative care: symptom relief, patient wishes, team-based approach [00:03:11 – 00:03:46]  Why hospital palliative care teams created the end-of-life association [00:06:13 – 00:07:06]  Vinca's 15-year journey from advanced care planning to full palliative care services [00:11:43 – 00:12:07]  The data: 42% ER reduction, 53% hospitalization reduction [00:12:52 – 00:13:31]  Patient story: metastatic pancreatic cancer, golf one month ago, ER the next [00:18:47 – 00:19:29]  Jill clarifies the hospice misconception: 90% of hospice care happens at home [00:22:50 – 00:24:10]  Why Medicare's fee-for-service model for palliative care is failing and what should replace it