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Lay Health Workers May Provide Value for Patients With Cancer in New Payment Models

Laura Joszt
As the healthcare system considers alternative payment models that reward high-value care delivery, programs that utilize lay health workers (LHW) may be valuable. A study in JAMA Oncology analyzed whether an LHW program can increase the documentation of patients’ care preferences.
As the healthcare system considers alternative payment models that reward high-value care delivery, programs that utilize lay health workers (LHWs) may be valuable. A study in JAMA Oncology analyzed whether an LHW program can increase the documentation of patients’ care preferences.

The study reviewed a 6-month program with an LHW assisting patients with end-of-life care preferences compared with usual care. The authors noted that interest in LHWs has increased over the years as the country deals with resource shortages and the healthcare industry moves toward value-based payment models.

“Although LHWs aid in cancer screening and treatment adherence, they are infrequently integrated into end-of-life care, and few randomized trials have evaluated their effectiveness in this setting,” the authors explained.

The 2-arm study was conducted at the Veterans Affairs Palo Alto Health Care System from August 13, 2013, to February 2, 2015, and included 213 patients with newly diagnosed stage III or IV solid tumors or those with recurrent disease. Participants were randomized 1:1 to either the LHW program integrated with usual care (intervention arm) or usual care alone.
The intervention arm consisted of a 6-month structure program with the LHW, during which the LHW assisted patients with advance care planning. The LHW first discussed topics in a 30-minute call that took place within 2 weeks of randomization followed by 15-minute, twice-monthly conversations either by phone or in person for 6 months or until patient death.

In the intervention arm, 92.4% of patients had their goals of care documented within 6 months of randomization compared with just 17.6% of patients in the usual care arm. The researchers found patients in the intervention arm were more satisfied with decision making and care compared with the patients in the usual care arm.

Patients in the intervention arm were more likely to use hospice services within 6 months of randomization (35.2% vs 18.5%), although the use of palliative care did not differ between the 2 groups. Healthcare use at the end of life also differed between the 2 groups with patients who died in the intervention arm having fewer emergency department visits and hospitalizations compared with the usual care arm. The intervention arm also had lower total healthcare costs in the last 30 days of life (median of $1048 vs $23,482).

“Our results demonstrate that an LHW, when integrated into cancer care, can improve patient satisfaction and reduce healthcare use and costs,” the authors concluded. “Given recent trends toward reimbursement models that reward high-value care delivery, LHWs may represent one solution, through greater discussion and documentation of care preferences, to more broadly address patients’ preferences and mitigate unwanted, burdensome, and costly care at the end of life.”

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