Blog Post | June 16, 2017

5 Key Components for Successfully Managing Advanced Illness within Broader Population Health Management Programs


Our new PIM™ model generated a lot of buzz at the recent AHIP Institute & Expo in Austin, Texas.  Congratulations to the AHIP team for planning and hosting such a successful event.

John Halsey Turn Key Health

John Halsey
VP, Business Development

While health plans expressed significant interest in PIM™ predictive analytics and its capabilities to identify members with serious illnesses, they understood that the real value is:

Deploying the PIM™ community-based palliative care teams led by Palliative Extensivists™, such as nurses and clinical social workers, to engage with members and improve care coordination, enhance the quality of life and lower costs.

It’s an approach that jump-starts initiatives to manage a plan’s most vulnerable patient populations – those with serious illnesses who may be nearing the end-of-life.

Here’s What Health Payers Are Looking For:   

  • Get ahead of negative quality and cost trends by utilizing sophisticated predictive analytics to identify patients well before they experience a costly over-medicalized or inappropriate death
  • Maximize efficacy by deploying specially trained professionals to engage with members facing an advanced illness
  • Ensure high quality and member satisfaction by standardizing approach and practice via electronic palliative care records and reporting
  • Create meaningful linkage between identification, engagement, enrollment, and intervention
  • Maximize ROI by convening existing palliative professionals in the community to solve the problem of appropriate intensity of service, reach and frequency

 

Why PIM™ Works

There’s consensus that payers need to have a specialized, distinctive process and approach to address members who are living with an advanced illness – and be able to scale their programs to meet demands of the large and growing number of patients.

While these members tend to be included under general population health management, payers appreciate that there is a need to treat them differently, both from an identification and engagement perspective, if they are to achieve the goals of the Triple Aim.

How it Works

A key differentiator of PIM™ is that it is an approach that goes beyond either predictive analytics or a staid conventional referral process that is often haphazard or comes too late in the process.

PIM™ leverages the synergies from both the integration of highly specialized predictive analytics + input or referrals from the field – case managers, discharge planners and others.
Our proprietary algorithms identify members with complex, chronic illnesses, and the model then features a community-based palliative intervention program that rapidly deploys existing interdisciplinary teams of highly skilled clinicians, primarily nurses and social workers.

Hyper-Local:  These specially trained Palliative Extensivists™ review and manage symptoms, address gaps in care, establish goals of care and develop care plans in conjunction with the medical home.

This makes predictive analytic data actionable and specific to this particular population.

PIM™ Palliative Care Teams led by Palliative Extensivists™

These nurses and social workers are experts at conducting meaningful, thoughtful conversations with members, families, caregivers and providers regarding healthcare decisions.

The Result:  Shared decision-making that advances a clear understanding of what members and families view as important near the end-of-life.

These discussions are critical to matching treatments to informed goals of care.  A sensitive dialogue between patients and their loved ones can avert costly, often unwanted interventions of questionable benefit and avoid inappropriate deaths.

The Value of Nurses and Clinical Social Workers

Palliative interventions that rely upon Palliative Extensivists™ – such as specially trained nurses and social workers – are proving to be exceptional resources for meeting the goals of quality, coordinated patient care.

  • Plentiful: There is an ample supply of Palliative Extensivists™ in virtually every community, representing a natural go-to source of professional talent.
  • Affordable and Scalable: This large pool of Palliative Extensivists™ makes it possible for home-based palliative care programs to be affordable and scalable for large populations.
  • Expands Reach and Frequency: A home-based palliative care team led by Palliative Extensivists™ expands the reach and frequency of ‘touching’ patient lives.

The traffic at our AHIP booth demonstrates the growing interest that payers have in our innovative model.  They clearly understand the value of effectively interacting and coordinating care with the medical home, advancing care coordination, reducing the cost of care, and enhancing patient/caregiver satisfaction.


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