Payers Adopt Innovative New Population Health Management (PHM) Models to Battle High Costs of End-of-Life Care
Death and dying are no longer taboo subjects.
After decades of attention and the dedication of resources toward generalized pop health solutions, the marketplace – payers, providers, and health IT professionals — is recognizing that PHM needs a specialized focus on health plan members and their caregivers facing advanced illness. The specialized needs of this population and the socio-economic impact of serious illnesses are placing care at the end-of-life as a high-priority topic for discussion.
To help payers better understand end-of-life care challenges, Turn-Key Health is releasing 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 challenges for health payers, providers, and members.
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.
End-of-Life Care Challenges
One-quarter of all Medicare dollars are spent on treatment during the final year of life, with one-third of the final-year expenditures squeezed into the last month before death. Over that period, 80 percent of spending is for hospital-based treatment, much of it in intensive care units (ICUs).
These spending issues are magnified by the extraordinary growth of the senior population and the likelihood that they will experience advanced illnesses. By 2050, the number of people on Medicare who are 80 and older will nearly triple, while the number of people in their 90s and 100s will quadruple.
With the looming insolvency of Medicare, payers are forced to dig deeper into the root causes of problems associated with advanced illnesses. Current PHM solutions are a step in the right direction. They represent a shift away from episodic to longitudinal care, and leverage generalized data analytics to forecast and track outcomes. But more is needed.
Matching Members with Appropriate Interventions
It’s important to move beyond a focus on disease process to one that is consumer-centric and emphasizes goals of care. Specialized solutions have become available to support matching patient needs with appropriate clinical resources. With greater specificity to identify high opportunity members, payers are able to match individuals with appropriate engagement — all delivered in the optimal home setting.
Evolving Population Health Management (PHM) Models Shift Focus to Quality of Life
We are now entering a new stage in the evolution of PHM, moving from a generalist to a more refined approach that supports specificity and aligns individual needs with resources that are best suited to drive improved outcomes. Today’s predictive analytics are capable of not only qualifying the needs for engagement and support services, but also quantifying the value of the interventions, from both a quality improvement and cost reduction perspective.
Care provided to members as they near the end-of-life is expansive and expensive, and requires special support and attention. During this timeframe, goals of care should shift toward a focus on comfort and quality of life.