Aetna’s Compassionate Care Program Incorporates Holistic, Member-Centric Case Management

Friday, June 22nd, 2012
This post was written by Cheryl Miller

When a loved one is dying, continued support and compassionate care from clinicians and case managers can be a “lifeline,” at least to one member whose spouse went through Aetna’s Compassionate Care program.

And that’s one of the main goals of the program, according to Dr. Joseph Agostini, senior medical director for Aetna Medicare, who spoke to the Healthcare Intelligence Network during its Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program, a 45-minute webinar on June 13, 2012: to provide additional support to members with advanced illness and their families/caregivers, and help them access optimal care, so they can get more of the kind of care they want, and spend less time in the ICU and hospital.

A person has advanced illness if

“…he/she has one or more conditions that progress enough that general health and functioning decline, and treatments begin to lose their impact.”

Aetna’s Compassionate Care Program is a nurse case management initiative that specifically targets patients with advanced illness, and it has had a major effect on healthcare utilization and quality outcomes, he said.

The need for such a program is crucial, Dr. Agostini said, given the increasing number of elderly people with advanced illness. Studies show that:

  • The rate and rise of older Americans is growing, and 10,000 baby boomers are aging into Medicare a day; and
  • The rate of Americans 85 years and older is growing; and
  • An estimated 30 percent of Medicare costs are incurred in the last year of life; and in the last month, 80 percent of costs are for hospitalizations; and
  • While most deaths occur in the hospital or nursing home, most Americans prefer to die at home.
  • While not a goal, Dr. Agostini stresses, the Aetna Compassionate Care program has increased hospice selection rate.

    The program relies on nurse case managers to identify members for the program, and then to act as a support system for them and the community supporting them.

    There is no specific training, instead, Aetna employs a “holistic, member-centric case management plan,” and RN case managers “should have the ability to support patients through all phases of life,” says Dr. Agostini. “Addressing patients holistically is crucial, because comorbidity is common, “ he explains. According to a JAMA study, people at the end of life value different things, including freedom from pain, and having family present, and Aetna’s goal is to honor the differences.

    Case managers can help members to understand their options, address pain and other symptoms, help plan advanced care support, and provide education and awareness of resources and online tools. Training is key, Dr. Agostini says, and includes motivational interviewing, technical training, and “lunch and learns.”

    Aetna’s involvement in compassionate care was prompted by significant gaps in care for the elderly, especially end of life care. Part of the problem is a serious shortage of specialists: data shows there is one oncologist per 141 new cancer patients versus one palliative medical doctor for every 1,200 patients with serious or life-threatening illnesses.

    And there are definite benefits to introducing palliative care options sooner. According to a study from the Dartmouth Atlas of Health Care, patients pursued less medically aggressive care but lived more than two months longer, had fewer depressive symptoms and improved mood and quality of life. The explanation could be that “earlier referral to hospice could lead to better symptom management.”

    As with any program, there are certain endemic challenges, including inadequate pain treatment, late referrals, difficulties determining prognosis, and lack of emotional support.

    But overall the program has resulted in significant results, including:

  • 82 percent reduction in acute inpatient days; and
  • 77 percent reduction in ER visits; and
  • 86 percent reduction in ICU days; and
  • Improved quality of life for Aetna members and their families.
  • This last result was perhaps most important for the member who reported on her husband’s passing in hospice while in Aetna’s program. Two days before their 49th anniversary he gave her a piece of jewelry that his daughter had helped him to purchase; it was something he’d done every year since they were married. Two days later he lost consciousness, but she expressed gratitude to the team for having been given this final memory.

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