The senior population in the United States is projected to grow by 135 percent by 2050, with the likelihood that many will experience some form of serious, life-limiting illness, and a pattern of intense spending.
This period of life is often marred by 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.
The financial and social fall-out can also impact family caregivers who spend nearly 66 hours a week providing care to a loved one during the person’s last year of life, eroding earning potential and imposing a profound economic toll.
Medicare beneficiaries with multiple chronic conditions are the heaviest users of healthcare services, with a management of multiple diseases and disabilities placing a significant strain on health systems and health plan/payer resources.
In fact, approximately 35 percent of the Medicare fee-for-service spend occurs in the last year of life, and one out of every four Medicare dollars – over $125 billion – is spent on care near the end-of-life. Source: Cutting the High Cost of End-of-Life Care
The Palliative Illness ManagementTM (PIMTM) is a new, unique option that successfully addresses the potentially devastating impact of over-medicalization in our aging society.
Designed for healthcare payers and at-risk provider organizations serving seniors, PIMTM deploys community-based palliative care teams complemented by predictive analytics and identifies individuals earlier in the disease trajectory to support patient and family caregiver engagement.
Executing on a strategy that is holistic, data-driven and evidence-based, this first-to-market offering of its kind nationwide:
• Integrates within broader population health initiatives
• Supports the shift from fee-for-service to value-based payment models
• Provides specialized capabilities to conduct progressive and difficult conversations around quality of life in the remaining months of life
• Enhances member and family caregiver satisfaction
• Avoids care that is costly, of questionable benefit or unwanted
What this means for payer-driven population health programs
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.
This approach has a positive, significant impact on the overall economic healthcare burden, mitigating patient and caregiver financial consequences and improving member/patient satisfaction.
Through partnerships with community-based palliative care teams and organizations across the country, PIM™ taps into the experience and synergies of existing resources that advance the best quality of life for patients and their family caregivers.
This specialized approach, with niche capabilities and expertise for conducting progressive and difficult conversations around the quality of life in the remaining months of life, avoids costly, inappropriate interventions and care that is fragmented, uncoordinated or inadequate to meet the patient’s growing needs and personal wishes.
The Palliative Illness Management (PIM™) works for payers – and their members
PIM™ emerges as an important element of a population health management (PHM) approach, offering a methodical, scalable program with structured and consistent processes that stand alone or plug into current PHM initiatives.
The Palliative Illness Management (PIM™) model effectively shifts the center of care to the home, placing the focus on care coordination and patient-centric services.
By generating outcomes and results that are measured and valued at a population level, and optimizing pre-and post-acute care, this approach reduces hospitalizations, re-admissions and number of ICU days, resulting in a drop in the average claims cost per member per month.