The State of State Health Policy: Governors’ 2016 State of the State Addresses
State of State speeches provide governors with an opportunity to highlight recent policy successes as well as outline key plans and issue areas of focus for the coming year. These speeches are generally strong indicators of governors’ main priorities and sometimes also include specific proposal suggestions and funding recommendations for deliberation by legislatures.
Currently, 31 governors are Republican, 18 are Democrats and one is an Independent. Two states—Kentucky and Louisiana—elected new governors in 2015. So far this year, 40 governors have outlined policy priorities through state of state speeches and/or budget addresses.[1] The chart and descriptions below summarize some of the main health-related themes from these speeches.
See a state-by-state comparison
Six governors mentioned the issue of more broadly addressing population health and building healthy communities.
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Launching Great State 2019 Plan in honor of state’s upcoming 200th birthday; initiative will focus on addressing longstanding problems from healthcare to prison reform and will involve building opportunities for citizens, and promoting education, healthcare, access to technology, job growth and economic opportunity |
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Highlighted poverty’s negative effects and mentioned state’s Two Generation initiative to address poverty that links with the state’s efforts to be the healthiest in the nation; initiative recognizes that residents’ health has economic and overall quality of life impacts; also importance of reducing children’s screen time and the need to promote healthier behaviors such as involvement in outdoor activities |
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Will be investing in issue of homelessness, which will include addressing the needs of the most vulnerable homeless, such as those with chronic health conditions |
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Need to make more coordinated investments and transform towards focusing more intensely on prevention and public health and paying for outcomes rather than volume and services |
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Noted that safe and healthy communities are the foundation of the state; to maintain the state’s high quality of life investments should continue in priorities that support economic growth |
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Mentioned consumer health concerns regarding access to safe and healthy food and the need for meaningful food labeling |
In addition to mentioning health care costs within the context of Medicaid, eight governors also spoke about state health care costs more broadly; often mentioning costs associated with state employee health benefits.
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Noted that state has not allocated enough funding to cover future retiree health benefits for state workers |
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Identified sharply rising health care costs as the state’s biggest challenge, particularly costs of state employee health plans; also importance of shifting from fee-for service health care to a system focused on high quality and affordable outcomes, and ensuring that individuals appropriately use care to help reduce overall costs |
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Commented on the rising costs of mandated health care expenditures for state employees |
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Mentioned state employee health care obligations as one of the state’s biggest fixed expenses, but recent changes to how these obligations are funded will save costs in the future |
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Noted state budget crisis and need for new revenue to avoid severe cuts in assistance programs for disabled individuals and other health programs and potentially having to close safety net hospitals |
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Noted that if state does not address $2 billion budget deficit will have to make significant cuts to basic state services, including health programs such as prescription drug assistance for seniors, services for individuals with mental illness and disabilities, and home and community-based services |
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Mentioned the rising cost of health care as the most significant challenge to the state’s budget and the overall economy as well as creates challenges for families and businesses; noted state’s current work to shift from fee-for-service to an all-payer model focused on better health outcomes and targeted provider spending |
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Commented on the need to reform the administration of state employee health insurance to achieve savings |
In total, 17 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 11 governors provided general comments about their states’ Medicaid programs in their remarks, such as commenting on recent program improvements or the growth of overall program costs.
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Mentioned commitment to implement Medicaid reforms to improve the state’s Medicaid program |
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Noted positive benefits of state’s Medicaid program but that there has been a significant rise in state Medicaid costs; requests legislature consider proposal to restructure taxes on Medicaid managed care organizations |
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Commented that state Medicaid costs have increased from $2.6 billion in FY2013 to $3.1 billion in FY2017 |
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Mentioned plans to move to a Medicaid managed care system to improve care coordination and address significantly rising state Medicaid costs |
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Recent reforms and modernizations to Medicaid program have demonstrated cost savings and also resulted in more client services and increased provider reimbursement rates |
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Access to in-home Medicaid services for individuals with developmental disabilities has significantly improved |
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Noted significant rise in state Medicaid costs |
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Highlighted the success of TennCare as a well-run system with high customer satisfaction ratings |
In total, 17 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 11 governors provided general comments about their states’ Medicaid programs in their remarks, such as commenting on recent program improvements or the growth of overall program costs. Thirteen governors mentioned Medicaid expansion in their speeches. Eight were governors that have not implemented expansion, and five of these governors spoke about the need to expand Medicaid or find another state-specific solution to cover the uninsured (Missouri, South Dakota, Utah, Virginia, and Wyoming). Two governors (Kansas and Nebraska) expressed continued opposition to expansion. Kentucky’s newly elected governor mentioned plans to transform the delivery of publicly assisted health care and to make changes to the state’s traditional Medicaid expansion, although the proposed budget contains funding for expansion in its current form.
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Noted expansion has resulted in greater health coverage for residents and state has benefited from increased federal revenue from expansion |
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Mentioned expansion has resulted in greater health coverage for residents |
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Highlighted the work of cabinet in exploring Medicaid expansion alternatives; also mentioned recently released plan to provide state-funded primary care |
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Mentioned state’s unique expansion program has resulted in increased access to health care and is based on personal responsibility |
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Noted continued opposition to implementing expansion |
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Mentioned plans to transform delivery of publicly assisted health care and to make changes to the state’s current Medicaid expansion; proposed budget contains funding for current expansion |
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Suggested state should act to cover the uninsured through expansion; can develop a state-tailored solution that rewards work and incorporates personal responsibility |
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Noted continued opposition to implementing expansion |
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Urged legislators to support continuation of the Health Protection Program, the state’s Medicaid expansion program, which has increased access to behavioral health services but will end in December 2016 without legislative action |
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Noted opposition to ACA but importance of considering expansion to make the best decisions for the state; current negotiations with federal officials to change reimbursement process for services provided to Indian Health Services enrollees could cover the state’s expansion costs; will not move forward on expansion without legislative budget authority or if any new general funds are needed; also detailed how cost projections for the expansion population were developed; encouraged any expansion legislation to include language to end expansion if the federal match is reduced |
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Noted flaws of ACA but urged legislators to find a state-tailored solution to covering the uninsured |
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Urged legislators to consider Medicaid expansion through a bipartisan, state-tailored solution |
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Noted opposition to ACA overall but that state should craft tailored expansion plan; commented on loss of federal revenue from not expanding affecting hospitals and businesses, and uninsured individuals lacking coverage; cited many organizations that support expansion (e.g. state business alliance and chambers of commerce) |
Two governors spoke about the topic of the ACA’s exchanges in their speeches.
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Mentioned plans to cease operations of the state’s exchange, Kynect, and that individuals will enroll through the federal exchange |
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Noted improvements in eligibility determinations and access to the state’s Health Connector in the past year |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. Governors’ frequently highlighted strategies that have been implemented or that they plan to implement to increase access to behavioral health services.
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Highlighted the issue of drug addiction; plans to convene a group of experts on substance abuse issues, recovering addicts and providers to identify appropriate treatments and reduce barriers to care |
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State is working to improve access to mental health care through State Innovation Model project; also plans to address links between suicide, mental illness and guns |
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State has significantly increased access to substance use treatment and is working with law enforcement to address overdoses; budget includes funding to provide team-based care for individuals in need of intensive treatment services; also plans for the Department of Health and Social Services to work with primary care providers to identify substance abuse issues earlier |
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Mentioned behavioral health issues as the underlying cause of many social, health and economic challenges and that mental health is the most pressing unmet health issue facing the state |
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Local behavioral health crisis centers have been effective; proposed budget includes funding for an additional center |
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Need to increase treatment options for drug addiction; will create task force on enforcement, treatment and prevention; also plans to build the first new mental health hospital in a generation |
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Highlighted the importance of addressing the needs of individuals with severe mental illnesses; will be launching a crisis prevention program for individuals ages 21 to 35 with severe mental illnesses and substance use disorders |
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Recent passage of state laws that increase access to substance abuse treatment; state still needs to “double down” on drug addiction and to treat it as an illness; committed to providing $100 million to improve access to mental health and substance use treatment by providing higher reimbursement rates for services and providers; plans to increase funding for three Accountable Care Organizations focused on providing coordinated physical and behavioral health treatment for Medicaid patients |
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In the past five years the highest amount of funding in the state’s history has been provided for mental health; legislation was passed to reduce prescription drug and substance abuse fatalities |
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Recent investments of over $700 million in the state’s mental health system to restore prior service cuts, but additional focus on the issue is still needed; proposed budget includes funding directed towards building a stronger mental health system |
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Substance abuse has become one of the most significant challenges in the state; have invested in treatment services and resources to publicize services, updated prescription drug monitoring efforts, and implemented other measures to reduce the oversupply of pain medication |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. The issue of heroin and other types of opioid abuse and overdoses were specifically mentioned by a number of governors in their remarks.
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Recently passed state law allowing healthcare providers to make an antidote available to address opioid overdoses and to allow Medicaid to cover inpatient detoxification |
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Plans to address heroin and opioid addiction; proposed budget includes funding for treatment programs and continuation of efforts to monitor prescription drugs |
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State is working to address heroin and opioid addiction through a state-level task force |
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Legislation being developed to address the heroin and opioid abuse epidemic by building capacity in prevention, education, and treatment efforts |
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Need for a prescription drug monitoring program to address the opioid abuse epidemic |
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State has worked to address the heroin and opioid abuse crisis but the issue remains the most urgent public health and public safety concern; efforts are underway to strengthen the state’s prescription drug monitoring program and improve access to treatment, but need further funding for law enforcement and efforts to strengthen prevention, treatment and recovery initiatives |
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Plans to launch a treatment intervention pilot program for individuals recovering from drug overdoses; individuals in recovery will help lead the intervention programs |
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State views opioid overdoses as a public health crisis; aiming to reduce overdoses by one-third in the next three years by investing in treatment, overdose reversals, prevention and recovery |
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State has coordinated trainings for first responders on administering Narcan, an antidote for opioid overdoses; plans to introduce legislation to expand access to Narcan without a prescription |
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Proposing funding to make a pilot program for overdose drug naloxone permanent; also funding for needle exchange programs, additional state staff resources and to develop a new treatment hub |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. Governors spoke about the issue of behavioral health within the context of better addressing the needs of justice-involved individuals, and providing mental health and substance use treatment services rather than incarceration when appropriate.
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Will be focusing on providing drug treatment and counseling to justice-involved individuals to help reduce recidivism |
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Mentioned justice reforms have diverted justice-involved individuals with substance use disorders to treatment rather than incarceration when appropriate |
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Bipartisan commission to reform the criminal justice system recommended enhancing cognitive behavioral therapy and substance abuse treatment programs in the corrections system |
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As part of the state’s justice policy reforms, will be focusing on rehabilitation instead of incarceration and on looking at funding models for drug and mental health courts |
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Proposing $1.6 million to reduce the number of severely mentally ill individuals cycling through jails and emergency rooms and to direct them to treatment instead |
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With reductions in the state’s prison population, one of the correctional facilities has been closed and will be converted into a certified drug abuse treatment facility for justice-involved individuals |
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Importance of addressing the behavioral health issues of justice-involved individuals; proposed budget includes funding for new crisis triage centers, mobile crisis response teams, and community behavioral health clinics |
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State has significantly increased the number of drug and DUI courts; more non-violent justice-involved individuals are receiving community treatment rather than being incarcerated |
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State has increased the number of drug recovery courts, resulting in reduced incarceration costs; proposing to invest more in these courts in order to offer services in all counties |
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Need to address issue of individuals with severe mental illnesses who cycle between jails and emergency rooms; proposed budget includes funding for four new 16-bed crisis triage facilities and three new mobile crisis teams |
Five governors noted issues related to the health care workforce, primarily commenting on strategies to address shortages.
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Mentioned physician and dentist shortage in nearly all of the state’s counties, and outlined plans to increase funding for medical scholarships and loan forgiveness for students committing to serve in underserved areas; also aims to create tax credits for rural providers and increase funding for 12 new residency programs |
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Noted that programs to train individuals in the health care field are expanding |
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Commented on need to address state’s lack of primary care physicians by maintaining funding for physician residency slots and providing medical loan reimbursement; also requests that the Board of Education work with the medical community and higher education institutions to develop plans to address the growing need for healthcare providers |
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Mentioned current state legislation that would permit the state to enter into a compact with other states to allow medical licenses to be interchangeable across states |
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Commented on how plans to expand employment training programs will help address healthcare workforce shortages; a task force will focus on developing innovative solutions to further address these shortages |
Some governors mentioned other specific health topics in their speeches, either as recent accomplishments or as future plans. These included topics such as enhancements to autism coverage, improvements in health coverage eligibility determinations, or lowered prison pharmacy costs.
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Mentioned that state will be providing health care coverage to children of undocumented workers; also state leads the nation in providing Medicaid home-based care, which also gives jobs to health care providers |
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Noted plans to partner with a national nonprofit organization to improve access to contraceptive options by offering better training for health care providers |
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Mentioned that in recognition of the need for private sector resources for Maui’s public hospitals, recently transferred hospital management to Kaiser Permanente |
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Will be forming a working group to address rural health care delivery issues |
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Addressed the water crisis in Flint and proposes support for increasing children’s access to health care and treatment for health issues associated with elevated blood lead levels |
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Highlighted passage of autism legislation to ensure that appropriate services are available through health plans; will expand services at existing autism centers and build a new center |
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Mentioned improvements at state’s Department of Health and Human Services have streamlined low-income residents’ access to nutrition assistance and other assistance programs |
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Mentioned that Department of Correction worked with TennCare to lower prison pharmacy costs annually by $5 million; proposed budget includes funding for a mobile seating and positioning unit in the Department of Intellectual and Developmental Disabilities |
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Noting the importance of helping individuals cope with health and mental health care needs to retain workplace talent, mentioned a recently completed informational kit for employers to provide to employees caring for family members with dementia or Alzheimer’s disease |
Using Peers to Support Physical and Mental Health Integration for Adults with Serious Mental Illness
People with mental illnesses use more resources and are more expensive to cover than Medicaid enrollees without these disorders. Moreover, the subset of adults with serious mental illness (SMI) has the highest per person cost of all disabled, non-dually eligible individuals enrolled in state Medicaid programs.
Trained peer support specialists are well positioned to bridge the gap between physical and behavioral health services for people with SMI as part of whole-person, recovery-oriented system of care. For state policymakers interested in better integrating care for individuals with SMI, this brief provides an overview of the use of peer supports in state mental health systems, and offers examples of the emerging use of these non-clinical staff as part of an integrated care approach. The brief also includes some key questions for state policymakers to consider as they explore the use of peer services to promote integrated care for Medicaid enrollees with SMI in their state.
Kansas – Medical Homes
In 2007, the Kansas Health Policy Authority (KHPA) (now known as the Kansas Division of Health Care Finance) delivered a comprehensive health reform plan to the Legislature and the Governor intended to improve health in Kansas. A key component of the plan was promotion of the medical home model. In 2008, Kansas lawmakers demonstrated support for adopting the medical home concept for Medicaid, Children’s Health Insurance Program (CHIP), and state employee enrollees by passing the Health Care Reform Act of 2008 (L. 2008, ch. 164), which statutorily defined the medical home. Following passage of that legislation, KHPA dedicated staff working with stakeholders to develop a Kansas-specific medical home model. However, due to budget shortfalls, the state did not launch a Medicaid/CHIP medical home initiative.
Through a Systems in Sync grant, the Kansas Department of Health and Environment provided support to the Kansas Patient Centered Medical Home Initiative (PCMHI) to support better care for children with special health care needs. Led by the state’s provider associations, eight practices received practice transformation support from TransforMed through in a two-year pilot with Blue Cross Blue Shield of Kansas with the support of the United Methodist Health Ministry Fund, the Sunflower Foundation, and the Kansas Health Foundation. Analysis of the program’s first year found improvements in same-day access, breast cancer screening rates, and hemoglobin A1c control among participating practices.
Federal Support:
- The Centers for Medicare & Medicaid Services (CMS) has approved one Health Home State Plan Amendment (SPA) in Kansas. Kansas’ SPA (approved 7/28/14, effective 7/1/14) covers Medicaid enrollees with one or more serious and persistent mental health condition enrolled in one of the state’s managed care organizations. For more information on Kansas’ health homes, visit the state’s health homes webpage or see the Program Manual. To learn more about the Health Home State Plan Option, visit the CMS Health Homes webpage.
Last updated: June 2015
| Forming Partnerships | Shortly after passage of the Health Care Reform Act of 2008 (L. 2008, ch. 164), the Kansas Health Policy Authority (now known as the Kansas Division of Health Care Finance) convened a broad stakeholder group to develop systems and standards for the implementation of the medical home in Kansas. Membership in the stakeholder group included a range of providers, consumers, insurers, safety net clinics, state health agencies, and information technology vendors. |
| Defining & Recognizing a Medical Home | Medical Home Definition: The Health Care Reform Act of 2008 (L. 2008, ch. 164) defined a medical home as “a health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost effective manner.” Health Home Definition: Section 2703 of the Affordable Care Act defined a health home as “a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team selected by an eligible individual with chronic conditions to provide health home services.” Health home services statutorily include: “comprehensive care management; care coordination and health promotion; comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; patient and family support (including authorized representatives; referral to community and social support services, if relevant; and use of health information technology to link services, as feasible and appropriate.” |
| Aligning Reimbursement & Purchasing | Health Homes: As the Lead Health Home Entity, each managed care plan receives a per-member per-month payment for each eligible member who is provided at least one of the six core health home services within a month. The rates fall into one of four cohorts, which vary based on patient complexity, ranging from $117.21 to $327.48 (statewide average: $171.79). The Lead Health Home Entity shares the payments with its contracted Health Home Partners, community-based providers who negotiate their own rates with each health home. Additional information on the payment methodology is available here. |
| Supporting Practices | Health Homes: The Kansas Department of Health & Environment contracted with Wichita State University to convene a learning collaborative to support program implementation. Learning activities have included a mix of in-person and remote activities designed to facilitate peer-to-peer learning and promote continuous quality improvement. A January 2014 report on the collaborative report is available here. |
| Measuring Results | Health Homes: In addition to the health home core quality measure set, Kansas identified four primary goals for the health home program (Appendix C): 1. Reduced utilization associated with inpatient stays; 2. Improve management of chronic conditions; 3. Improve care coordination; and 4. Improve transitions of care among primary care and community providers and inpatient facilities. |
Kansas
In Kansas:
- Medicaid services are delivered on a managed care basis, and KanCare (Kansas Medicaid) members are assigned to one of three managed care organizations (MCOs). Kansas operates KanCare through a Section 1115 Waiver, which was approved in 2012, and went into effect in January 2013. The KanCare MCOs provide most Medicaid services and are responsible for physical, behavioral and long-term care services. Some of the MCOs use subcontractors to provide certain services, such as a behavioral health, dental, and vision services.
- Prior to the transition to KanCare there were a total of 354,664 beneficiaries enrolled in Kansas’s Medicaid program as of July 2011. Of these 310,036 were enrolled in managed care programs. According to a KanCare quarterly report, there were a total of 330,019 beneficiaries enrolled in KanCare MCOs as of December 31, 2013.
- Kansas also delivers Home and Community Based Services (HCBS) through seven HCBS waivers including six that include children among the target population: autism, physical disability, intellectual/developmental disabilities (I/DD), technology assisted, traumatic brain injury, and serious emotional disturbance. In January 2014 Kansas received approval to incorporate the HCBS and targeted case management services for I/DD individuals into KanCare.
As of 2013, 280,343 individuals were eligible for KAN Be Healthy (KBH), Kansas’s Medicaid benefit for children and adolescents (also known at the Early and Periodic Screening, Diagnostic, and Treatment benefit, or EPSDT). According to CMS data from 2013, Kansas achieved an EPSDT screening ratio of 82% and a participation ratio of 58%. 119,617 children received dental services of any kind, with 112,350 receiving preventive dental services.
Last updated June 2014
| Medical Necessity |
The State of Kansas defines medical necessity as follows:
“Medical necessity means that a health intervention is an otherwise covered category of service, is not specifically excluded from coverage, and is medically necessary, according to all of the following criteria:
Kansas statutes also add that KAN Be Healthy services (see pgs. 60-61) also include:
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| Initiatives to Improve Access |
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| Reporting & Data Collection |
KanCare, as part of its Section 1115 Waiver, has a significant quality measurement component. Additionally, each of the three KanCare health plans and their subcontractors are required to obtain accreditation by the National Committee for Quality Assurance.
In terms of Evaluation Design of its 1115 Waiver, Kansas incorporates different measures from the KanCare contracts related directly to the goals of the KanCare program. This includes quantitative measure such as: Healthcare Effectiveness Data and Information Set (HEDIS); mental health measures including Serious Emotional Disturbance (SED) Waiver reports and National Outcome Measures; Substance Use Disorder measures; and Case Record reviews. Kansas also includes a number of qualitative reports such as: Consumer Assessment of Health Plans Survey (CAHPS), Substance Abuse Disorder consumer surveys, Provider Surveys, and other reports/surveys.
KanCare also has a pay for performance (P4P) program that ties payment to six performance measures related to operations for the first year, and fifteen performance measures related to quality for the later years. Among the fifteen quality measures that Kansas will be tying to payment are: well-child visits in the first 15 months of life and preterm births.
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| Behavioral Health |
The three KanCare MCOs are required to cover behavioral health services; and some use subcontractors to provide these services. Kansas also has a HCBS waiver for individuals age 5 and over who meet thee definition of having a developmental disability or are eligible for care in an Intermediate Care Facility. As of January 2014 this waiver and the services provided are incorporated into KanCare. The services from this waiver that are now provided by KanCare include long-term services and supports services and targeted case management.
Kansas is also working on an Affordable Care Act Section 2703 Health Homes State Plan Amendment that will be used to provide comprehensive and intensive coordination of care to those with Serious Mental Illness and Chronic Conditions. Kansas anticipates launching its Health Homes effective July 1, 2014.
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| Support to Providers and Families |
Support to Providers
The KanCare website offers information to providers on how to become a KanCare Provider as well as information on each of the health plans.
Support to Families
Kansas Medicaid has developed a KAN Be Healthy Kontact Korner document, which provides information and links on topics such as physical and developmental growth, dental, nutrition, immunization, blood lead, hearing and vision. Kansas has also held a series of events for consumers to provide information related to the roll out of KanCare, the integration of I/DD services, and the Section 2703 Health Homes State Plan Amendment.
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| Care Coordination |
KanCare expects that the health plans are actively engaged in care coordination for their members. One of the KanCare Contracting Principles, as identified in the Section 1115 Waiver that created KanCare, is that the health plans are required to perform a number of functions related to care coordination. This includes undertaking a health risk assessment to identify health and service needs in order to develop care coordination and integration plans for each member. Additionally, there are several measures among the quality measures that are tied to Kansas’ pay for performance program that are related to care coordination, or indicate that care coordination is occurring, including:
Care coordination is also a central part of Kansas’s Section 2703 Health Homes State Plan Amendment. Kansas defines its health homes as: “A team of health professionals: May include a physician, nurse care coordinator, nutritionist, social worker, behavioral health professional (including mental health or substance use disorder providers), and can be free standing, virtual, hospital-based, community mental health centers, etc.”
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| Oral Health |
Dental Screens are part of a KAN Be Healthy visit. The Health Plans, or their subcontractors, provide dental services to all children eligible for KAN Be Healthy, including more advanced dental services as deemed medically necessary. |
Kansas
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.
Last updated: October 2012
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
