The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: CHF (page 1 of 5)

Hospitals in Michigan: Growing a Palliative Care Program

Melinda Gruber

Melinda Gruber MBA, PhD, is the Chief Executive Officer for Caring Circles.

Palliative care provides a number of benefits for patients of all diagnoses including Congestive Heart Failure (CHF). During the CHF workgroups a topic for discussion was how palliative care programs can reduce readmissions and the MVC Hospital Engagement team found out more about some palliative care programs here in Michigan.


Lakeland Hospital started their palliative care program in the outpatient sector through a local independent hospice after recognizing that patients would benefit from improved symptom and pain management along with advanced care planning. By 2008, Lakeland realized they needed to engage a physician champion who was both well-known and accepted throughout the community with a vision for both inpatient and outpatient palliative care. In 2012, the outpatient hospice program joined Lakeland and a business plan was proposed to add an inpatient program. This program has grown and received positive feedback, and Lakeland now has a Hospice and Palliative Medicine Fellowship. Recently they have worked with home care and have started to provide a palliative home care service that is actively growing. As the program evolves, Lakeland continuously assesses the needs of the program to determine where to best allocate resources.


The benefits of the palliative care program at Lakeland include an added layer of support for both patients and their families. Additionally, examples show reduced readmissions, better pain and symptom management, increased support for the family, and patients meeting their goals in end of life care surrounded by family who have been prepared.

While partnering with other outpatient and inpatient palliative care programs throughout the area, Lakeland is learning the strengths of each to provide for the varying needs of the patients.


One of the challenges Lakeland faces is an ongoing lack of understanding about palliative care and its true value to the patient. There is also the challenge to convince the provider that the palliative care team is there to assist with the patient’s needs and not completely take over care of the patient. To address these challenges, the palliative care program at Lakeland takes on the responsibility of educating and coaching staff to provide them with a minimum foundational skill to deliver palliative care and explain how and why the palliative care approach was taken. This helps those involved in patient care understand the different approaches to care given, and how the palliative care program works.

Other challenges being faced by Lakeland are identifying what the optimal approach for palliative care is, staffing needed to provide palliative care and setting expectations to deliver consistent care.


Lakeland partners with Agency on Aging which includes an interdisciplinary team that goes to a patient’s home and provides dietary and medication advice. Lakeland’s palliative care program also has relationships with primary care for the homebound, nursing homes, hospitalists, hospices, intensivists, and consultation programs for all-inclusive care.


Lakeland stresses the importance of palliative care education and provides opportunities for growth in learning such as:

  • Huddles with the hospitalists and working more with the residents;
  • Lunch and learns for CME credits; and
  • A patient care summit on the benefits of palliative care


As the palliative care program at Lakeland continues to grow, the palliative care team perform needs assessments to ensure the program is meeting the needs of the patient and the health system. They also utilize data in a simplistic understandable way to demonstrate the value of the program to high level leadership. Moving forward, they have scheduled to attend meetings at provider offices to build relationships and provide educational opportunities to clinicians.


Lakeland advises other hospitals to recognize that there is not one set way to provide palliative care. They recommend setting expectations up front, developing objectives to meet the needs of both the patient and the health system, and finding “champions” and get them engaged in palliative care initiatives.

Lakeland is also seeking advice for how clinicians can be consulted ahead of a patient “crisis”. Team members are currently on call 24/7 but they would like to find ways that the team can be more consistent with providing consults especially in the off shifts.

If you would like to learn more about the palliative care program at Lakeland Hospital, please contact Doris Glowacki at or the MVC Coordinating Center.

Recognizing the Value of Palliative Care as Part of Comprehensive Health Care

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Palliative care programs aim to maximize patient comfort, relieve distress, and provide support to patients and their families.  Patients do not need to be diagnosed as terminal to benefit from palliative care. Studies have found palliative care programs increase patient satisfaction with treatment while decreasing costs.  As a result, health care organizations around the nation are working on introducing or strengthening palliative care programs to help advocate for more holistic patient care beyond the chronic illness.

According to America’s Care of Serious Illness: 2015 state-by-state report card on access to palliative care in our nation’s hospitals by the National Palliative Care Registry, Ohio has a 2015 Report Card letter grade of A, compared to Michigan’s B grade.1 In this report, hospitals were given a letter grade of A-F based on its access to palliative care programs.Despite its benefits, physician referrals to palliative care are low – only 13% of cardiac patients are referred to palliative care.2  To improve access, some outpatient clinics in Ohio have partnered with community-based programs specializing in palliative care.  In addition to providing care to the patient, the community-based program offers education to clinicians on what palliative care entails and how to refer patients.

Similarly, a recent study at John Hopkins Medical Institution (JHMI) explored the cost-effectiveness of its existing palliative care program to determine whether an expansion was warranted. By using admissions data, JHMI studied the financial outcomes of their palliative care program on patient care over the course of 13 months. The impact of the palliative care program was significant, as there was a total positive financial payoff of nearly $3.5 million for the health system. This financial impact emphasizes that value-based program models focusing on patient-centered care not only benefit the patient experience but also benefit health system finances. More about this study and the methods used can be found here:

Nonetheless, palliative care programs across the nation are each unique and beneficial in their own ways. Some health systems have taken a community approach to palliative care, while others seek to strengthen their programs through clinical fellowships, consultation programs, and expansion. Following the CHF workgroup last month, the Coordinating Center created a Palliative Care and CHF brochure that highlights different facts, figures, and initiatives related to palliative care that can be helpful for hospitals interested in refining or expanding their respective programs. This can be found in the MVC Registry under Resources. For more information on the brochure or workgroup, please contact Deby ( or Abeer (

Also keep an eye out for future blog posts highlighting hospitals in Michigan that have exceptional palliative care programs and emphasize a positive patient experience!


1 National Palliative Care Registry. America’s Care of Serious Illness: 2015 state-by-state report card on access to palliative care in our nation’s hospitals.

2 National Palliative Care Registry. How we work: Trends and Insights in Hospital Palliative Care

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