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Journal Article


Changing the Conversation in California About Care Near the End of Life



The Issue

Many terminally ill patients who would benefit from transitional and palliative care at the end of life do not receive these services and instead receive unwanted and inappropriate care, leading to dissatisfaction among patients, their families, and their providers.

The Innovation

Sutter Health, a nonprofit integrated delivery system in California, launched an integrated system of care for patients with late-stage chronic illnesses. The program provides home-based transitional and palliative care, as well as patient counseling, with a goal of decreasing unwanted acute care and increasing hospice use. Physicians and other providers have an easier time referring patients to the program than to hospice because unlike hospice, the program does not require patients to give up curative treatment to receive services.


Forty-seven percent of terminally ill Medicare patients enrolled in the program were discharged to hospice from 2003 to 2005, compared with 20 percent who did not participate in the program. Patients participating in the program between Nov. 2009 and Sept. 2010 who lived at least 30 days experienced 68 percent fewer hospitalizations during the 30 days after enrollment compared with the 30 days before. The average savings per patient was approximately $2,000 per month.

Publication Details



H. Meyer, "Changing the Conversation in California About Care Near the End of Life," Health Affairs, March 2011 30(3):390–93.