Health Plan Medical Directors Adopt New Palliative Care Model
Health Plan Medical Directors Adopt New Palliative Care Model for Members with Advanced Illness
Today’s health plan medical directors are innovative leaders, always seeking new solutions and opportunities to overcome tough challenges. As they take on a wider range of responsibilities that require a greater focus on strategic business issues — such as the quality and cost of care for members with serious, advanced illnesses – they are discovering a new model for providing palliative care.
Many now regard models like Palliative Illness Management™ (PIM™) as the optimal solution. Offered by Turn-Key Health, PIM™ extends the value of a plan’s population health management (PHM) program and enhances the quality of life for these fragile, vulnerable patients.
By integrating PIM™ within existing broader PHM frameworks, medical directors make it possible for their plans to leverage sophisticated predictive analytics to identify patients who are high opportunity — not simply high cost — for introducing specialized community-based palliative care services. This level of care supports members to remain at home and avoid non-beneficial treatment, rather than experience episodes of acute care at the end-of-life.
It’s a highly scalable model, leveraging the clinical resources of Palliative Extensivists™ (PEs™), including nurses and social workers practicing at the top of their license.
Through its established relationships with PEs™, who are available in the local community, PIM™ enables payers to match appropriate resources to individual patient needs, increase the reach and frequency of patient engagements, and scale programs for large populations.
In this model, physicians serve as the fulcrum of care with the palliative care team reporting back findings when appropriate and assisting in care coordination directly with the physician.
Relying on the Experts
PEs provide in-home and telephonic assessments, including pain and symptom management, medication reconciliation, care coordination, goals of care discussions and advance care planning. They develop care plans in conjunction with the treating physician, supporting existing doctor-patient relationships and the medical home. All interactions are captured within Turn-Key’s PIM™ platform, which guides, tracks and measures program success.
As experts in conducting discussions regarding treatments that meet patients’ personal wishes, PEs promote shared decision-making that advances a clear understanding of what members and families view as important at the end-of-life. This helps to match treatments to informed goals of care, avert costly, often unwanted interventions of questionable beneﬁt and avoid inappropriate deaths.
They also provide social support, relieve caregiver burdens, manage symptoms, offer medication management and provide disease specific education. This approach allows for a scalable and financially feasible PHM solution and removes the need for time-intensive recruitment and hiring of expensive resources.
A one-year program tested and validated this clinician-led program for approximately 1,000 seniors enrolled in a Medicare Advantage plan: enrolled cohort, 208; control group 800.
Learn more about this specialized approach and our outcomes by downloading the case study.