Blog Post | December 7, 2016

2017 Forecasts Growing Need for Community-Based Advanced Illness Management

Written by: John Halsey, VP Business Development, Turn-Key Health  

John Halsey Turn Key Health

John Halsey VP, Business Development

With healthcare changes underway, one thing is for certain: the year ahead will likely include more emphasis on maintaining quality care at reduced cost while improving patient satisfaction.

With some analysts predicting a troublesome economy, the financial and social consequences of life-limiting illnesses may be magnified, with a ripple effect on family caregivers and health plans that are also saddled with economic burdens. As adjustments to the health system are enacted, they will resonate throughout the entire healthcare system.

The good news is that there is a new, innovative option for delivering Advanced Illness Management (AIM) – with opportunities to better plan and be prepared for the climate of healthcare transformation under a new administration.

Palliative Illness Management™ – PIM™, a subset of AIM, emerges as an important solution for healthcare payers and at-risk provider organizations.  By effectively integrating available community-based assets and resources into a structured and consistent population health management (PHM) strategy, PIM™ delivers community-based palliative care for this vulnerable population.

PIMTM deploys local, in-home palliative care teams complemented by predictive analytics, and identifies individuals earlier in the disease trajectory.  It offers a platform to support patient and family caregiver engagement. Individuals with advanced illness who might otherwise go undetected by traditional means are identified earlier in the progression of a disease, ensuring that gaps in care are recognized and closed.

Shifts care to the home or community setting. This places the focus on care coordination and patient-centric services.  With expertise and unmatched resources, this new model advances the best quality-of-life for patients and their caregivers. Results document exceptional levels of satisfaction with the quality of care, which translates into enhanced member and family satisfaction with their health plan participation.

• Healthcare costs DOWN 33 percent[i]

• Inpatient Hospitalizations DOWN 43 percent[ii]

• Total Hospital Costs DOWN 30 percent[iii]

• Total Number of Hospitalizations DOWN 74 percent[iv]

• 30-Day Re-Hospitalizations DOWN 68 percent[v]

Advanced Care Planning. Sensitive, thoughtful advanced care planning by trained palliative care professionals improves patient-centered outcomes such as pain, depression and other symptoms, and avoids costly, inappropriate interventions and hospitalizations.

Specialized support, niche capabilities and expertise for conducting progressive and difficult conversations around the quality of life in the remaining months of life help patients and families in several ways: set the goals of care and avoids costly, inappropriate interventions that may be unwanted or of little benefit. Spiritual support and volunteers may also play an important part in this engagement.

This is a welcome change in light of a survey issued earlier this year by Nielsen Strategic Health Perspectives and Council of Accountable Physician Practices. It concluded that only half of patients experience benefits of care coordination in which providers talk with patients.

Supports the payers’ shift from fee-for-service to value-based payment models. This allows payers to integrate within broader population health programs and take advantage of a methodical, scalable program that stand-alone or plugs into current PHM processes. Outcomes and results are measured and valued at a population level.

Addresses care coordination and care transitions. Existing palliative care teams focus on pre- and post-acute care, crucial aspects of the healthcare continuum that remain fragmented.

One survey: Care Redesign Survey: Strengthening the Post-Acute Care Connection of healthcare executives conducted by NEJM Catalyst showed that only 30 percent of the 375 surveyed reported that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7 percent reported they were fully coordinated.

Looking ahead, PIM™ reflects the progressive, industry-wide belief that care decisions in advanced illness should be primarily driven by the values, goals, and preferences of the individual who is ill and his/her family members. Individuals often suffer through unnecessary, costly and even harmful treatments, despite overriding expert opinion that when patients have a terminal illness and the outlook for recovery dims, more treatment does not equal better care.

For payer-driven population health programs, this approach lowers the cost of claims, delivering a positive, significant impact on the overall economic healthcare burden. Members and caregivers avert financial consequences and report greater satisfaction with care and plan participation.

Whatever lies ahead, the unique capabilities of PIM™ empowers all stakeholders to face the consequences of advanced illness with greater confidence.

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