Recalibrate PHM End-of-Life Care Strategies: A Business Perspective for Health Payers
It’s no secret that health payers have a list of pain points when it comes to addressing the challenges of providing quality care, creating associated care strategies, and reducing the cost burdens of end-of-life care.
With a growing population of members and caregivers facing advanced illness, health plan leaders are taking a more focused approach to care delivery.
Many payers are re-thinking end-of-life care within the broader confines of their population health management (PHM) strategies, moving from a generalized approach to one that is far more specific and targeted to this vulnerable population.
Population Health Management Meets Community-Based Palliative Care
To help payers better understand end-of-life care challenges, Turn-Key Health has just released the first installment of its three-part white paper, “Effectively Addressing the Impact of Advanced Illnesses.” The series expands the understanding and analysis of the 12-18 month time period during the last stages of serious illness, and examines the socio-economic impact for health payers, providers and patients.
Part One, “Re-calibrating Population Health Management to Include Community-Based Palliative Care,” examines specific issues for health payers, and underscores the value of integrating an innovative new model, Palliative Illness Management (PIM™), within existing, broader population health management (PHM) frameworks.
Predictive Analytics Identify Members for Advance Illness Management
Turn-Key Health has introduced a robust, specialized population health management (PHM) solution serving payers and their members with advanced illness. Appropriately entitled Palliative Illness Management™, PIM™ enables payers to implement a structured, scalable process that drives consistent quality outcomes. It’s an end-to-end approach that begins with sophisticated predictive analytics to identify members who are high opportunity — not simply high cost – and completes the circle by introducing a specialized community-based palliative care program.
This level of care is optimally provided in the home by specially trained nurses and clinical social workers practicing at the top of their licenses. When supported by a model that includes a standardized platform to instruct and guide interventions, these professionals capture engagement data in order to improve outcomes, as well as to measure and report success. In this role, they serve as an important bridge to the medical home, addressing medical, emotional and social issues.
Palliative Care Addresses Challenges of Serious Illnesses
To engage these patients and caregivers, Turn-Key Health convenes community-based palliative care teams, recognized under the PIM™ model as Palliative Extensivists™ (PEs) — primarily nurses and clinical social workers practicing at the top of their licenses.
Risk-based workflows and palliative care assessments facilitate evaluation of patient/family needs, and expand the reach of case managers, Primary Care Physicians (PCPs), and other specialists. Utilizing formalized telephonic and home visit assessments and questionnaires which are embedded in the Turn-Key platform, the PEs provide and document uniform, standardized and expert-level palliative care to patients.
These clinical resources typically reside as a separate service within local hospice and palliative care organizations. Through Turn-Key, PEs are available in virtually every community, allowing payers to increase the scope and frequency of “touching” individual patient lives, matching appropriate resources to individual patient needs, and scaling their programs for larger populations.
Examines specific issues for health payers, and underscores the value of integrating an innovative new model, Palliative Illness Management (PIM™), within existing broader PHM frameworks.