Blog Post | May 9, 2019

Managing End-of-Life as its Own Disease State


Don’t miss John Halsey, Vice President, Payer Development, Turn-Key Health when he presents “Engaging a Medicare Population in Managing End of Life Decisions,” at this year’s fourth annual Population Health Payer Innovations for Medicaid, Medicare & Duals, 11:50 a.m. Wednesday, May 15.

“We are witnessing the gradual expansion for defining end-of-life to extend beyond the last few months, with trends and strategies to be discussed during the upcoming presentation, including Primary Care First, hospice carve-in and supplemental benefits,” says Halsey. “Changing reimbursement is a given, and will have an impact on the entire healthcare system – especially payers that are managing the quality and cost of care for seriously ill members.”

Halsey notes that going forward, it will be important to treat and manage end-of-life as its own disease state, adding, “This is where community-based palliative care (CBPC) is proving to be a better way for payers to improve quality and manage costs for seriously ill members nearing end-of-life.”

Palliative Care Models and Trends


This presentation spans a wide range of topics:

  • The role of community-based palliative care (CBPC) and its iterative models
  • Identification of patients on an end-of-life trajectory
  • Changing landscape and supplemental benefits
  • Hospice carve-in demonstration project
  • Primary Care First

There is a growing awareness that end-of-life decisions are critical within a Medicare population. The value of preparing, discussing options and then coordinating those decisions can be very valuable to the member, the physician, the family and the health plan. Having a formal program with dedicated personnel can provide a key mechanism within a health plan to provide this service and enable the member to better manage their health all the way through their life.

There are a few key elements within this type of program that always need to be considered and this presentation will provide those key elements for consideration:

  • How to evaluate the population for a palliative care program
  • Implementation considerations
  • Outcome measures

Learn More About CBPC

A growing number of payers recognize the value of home-based CBPC as a multidisciplinary approach to specialized care for people with an advanced or serious illness.

This type of care includes a variety of models designed to meet the needs of seriously ill individuals and their families, outside of the hospital setting.

Innovative approaches within broader population health management (PHM) programs address the medical, emotional and socio-economic burdens of an advanced or serious illness and improves outcomes for members by addressing SDoH.

Gain Greater Insight into SDoH

Because SDoH accounts for up to 60 percent of health outcomes, many health insurers focus on addressing SDoH, evaluating every aspect of a population, from community resources like YMCA discounts and diabetes education to access to transportation or child care.

Evidence shows that stress negatively affects health across the lifespan and that environmental influences may have multi-generational impacts. For instance, smoking, diet, exercise, loneliness and social isolation represent the most important determinants of premature death.

Hear More About CMS’ Expanded Services

CMS has introduced regulatory and legislative policies to give Medicare Advantage (MA) plans more flexibility and expand the types of services – including palliative care — that can be covered to address SDoH.

A palliative care partner, like Turn-Key Health, can help to optimize care in the home for those living with a serious or advanced illness, improve outcomes, lower costs and enhance member/caregiver satisfaction.

Our Palliative Illness Management™ (PIM) solution allows payers to identify more seriously ill members on a real-time basis, better coordinate care and rapidly scale home-based services across broad geographies to achieve consistent care quality.

 

Find Out How Turn-Key Addresses Hospice Carve-In

The MA carve-in is set to take effect in 2021. The Turn-Key solution aligns with payers, providing more cost-effective home-based care management for members with an advanced illness, engaging hospice at the appropriate time and enabling MA plans to capitalize on new reimbursement guidelines for offering palliative care as a supplemental benefit.

Our model not only supports the Centers for Medicare & Medicaid Innovation (CMMI) initiative but is also proven to achieve a 15-percent reduction in member healthcare consumption related to earlier and appropriate election of the Medicare hospice benefit.

Learn About New “Primary Care First” Model Options

The presenters will review the impact of a recent April 2019 press conference, when Secretary Azar, CMS Administrator Verma and CMMI Director Boehler unveiled a new Primary Care First Model Option.

Primary Care First is based on the underlying principles of the existing CPC + model design:

 

 

This new primary care model includes a Serious Illness Population (SIP) component that specifically welcomes the participation of hospice and palliative care providers

Schedule A Meeting

Interested in meeting with us at the upcoming Population Health Payer Innovations for Medicaid, Medicare & Duals Forum? Click here to schedule a meeting.


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