Posts Tagged ‘Palliative Care’

Guest Post: Innovative, Specialized Palliative Care Programs Help ACOs Improve Patient Care, Achieve Success in Medicare Shared Savings Program

September 13th, 2018 by Greer Myers

Home-based Palliative Care

A structured, systematized approach to home-based palliative care: One of the most effective ways to manage and enhance care delivery for vulnerable, costly populations.

Under the new Medicare Shared Savings Program (MSSP), Accountable Care Organizations (ACOs) will be required to take on more risk as a rule of engagement and participation. The Centers for Medicare & Medicaid Services (CMS) is also shrinking the amount of time ACOs can be in an upside-only model to two years, putting additional pressure on ACO leaders to initiate changes. Currently, 82 percent of ACOs participating in the MSSP are in an upside-only model.

This has prompted many organizations to seek innovative strategies that will enable them to remain in the program and achieve success. One proven approach involves the adoption of a structured and systematized home-based palliative care program designed to identify patients with serious or advanced illness earlier in the disease process and offer them services outside of the hospital setting.

The palliative care team, primarily specially trained nurses and social workers, addresses the unique needs of the patient and family, taking into consideration their culture and values when developing a patient-centered approach to care. The team coordinates patient care across the continuum, which may include specialty care, acute, post-acute and community-based care needs.

For ACOs facing tight timeframes for implementing programmatic changes, this structured approach to community-based palliative care can be rapidly deployed in any geographic area and quickly scaled for larger populations.

Supporting the Medical Home

Home-based palliative care programs align with the medical home model through the provision of specialized care for people living with serious or advanced illness. Sharing priorities with the medical home, both emphasize the importance of care in the home, providing appropriate social services, clinical assessments and referrals, and partnering with physicians to deliver a solution that is patient-centered, data-driven and evidence-based.

A structured, systematized approach to home-based palliative care is one of the most effective ways to manage and enhance care delivery within this vulnerable, costly population. Quality controls and reporting are essential to improving quality and decreasing cost. Programs offering modular continuing education to palliative care team members, as well as guided tools and electronic patient assessments, enable highly skilled clinicians to maximize the impact of member outreach, enrollment and engagement.

Palliative care teams extend the reach and frequency of patient engagement, establishing collaborative relationships and reporting with the medical home that further strengthen care coordination. This level of connectivity and interaction with the medical home represents a significant opportunity to affect quality and cost.

Advantages for Patients and ACOs

Populations burdened by a serious or advanced illness place incredible strain on ACO resources, compromising the organization’s ability to improve care while generating shared savings under the MSSP model. By adopting the medical home/home-based palliative care approach, ACOs can turn this high cost population into an opportunity: improving quality and patient satisfaction while reducing cost and generating shared savings through reduced unnecessary hospital admissions, readmissions and ICU stays. Furthermore, this approach avoids over-medicalized care and high-cost services that may not align with the patient’s goals of care.

Integrating home-based palliative care within the medical home model ensures that each member is treated with respect, dignity, and compassion. This leads to a better quality of life, thanks to strong and trusting engagement with specialized palliative care professionals. Overall, this integrated model aims to improve quality and care coordination, so that individuals access care in the right place, at the right time, and in the manner that best suits a patient’s goals of care.

What’s more, specially trained palliative clinicians act as an extension of the primary treating physician and strengthen the medical home. The palliative nurses and social workers establish goals of care, provide supportive home-based care and assess patient and caregiver status, reporting relevant information to the primary treating physician to fill gaps in care and better align goals with care received.

Innovation in the Real World

Let’s consider a typical patient experience that is all too familiar: An 89-year old man with congestive heart failure (CHF) experienced five emergency room visits and five hospital admissions in one year before his condition worsened and he was intubated in the ICU. Prior to this, he had been seeing his cardiologist and primary care provider for adjustments to his medications, which he was unable to manage at home.

Now consider the vastly better approach of in-home palliative care: This same patient would have informed providers he did not want to go to the hospital or have intubation. When his health deteriorated, his social worker would have met with him and his family to discuss palliative care and supportive care options. He would have also been placed on the palliative care program with home visits made by palliative care specialists as needed. When the time came, his palliative care specialist would have evaluated hospice options with the patient and his family, and he would have died in the manner of his choosing – peacefully at home.

An innovative palliative care approach provides specialized patient/caregiver support and enhances communication with the primary treating physician. This facilitates a shared decision-making model, which results in better congruence between a patient’s individual goals of care and medical care received. It is a recipe for improving quality of life and satisfaction with the care that is delivered.

Greer Myers

Greer Myers

About the Author: Greer Myers is the president, Turn-Key Health and executive vice president, chief development officer, Enclara Pharmacia. With more than 20 years of healthcare experience, Mr. Myers joined Enclara Healthcare in 2014, and maintains dual roles as its President of Turn-Key Health and its EVP of Corporate Development of Enclara Pharmacia. Bringing strengths in post-acute operations, mergers and acquisitions, pharmacy benefits management, strategy and business development, he also has strong vertical experience in payer, provider and healthcare IT verticals.

Infographic: Decision-Making in Cancer Care

March 6th, 2015 by Melanie Matthews

Cancer patients should be involved with decisions about their care and should understand the goals of treatment and prognosis of their disease, according to a new infographic by the National Coalition for Cancer Survivorship.

The infographic examines the current state of prognosis and end-of-life care discussions.

2014 Healthcare Benchmarks: Palliative CareWhile the word ‘palliative’ literally means to cloak or conceal, healthcare is taking the wraps off this critical service — in spite of provider resistance. Recent data increasingly supports the thesis that a well-timed palliative care consult can enhance the patient experience and foster appropriate use of healthcare resources.

2014 Healthcare Benchmarks: Palliative Care documents emerging trends in palliative care at 223 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience — two critical markers of healthcare performance.

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9 Things to Know About Palliative Care

June 12th, 2014 by Cheryl Miller

With an aging population that is living longer—an estimated 10,000 baby boomers become eligible for Medicare each day — and a shortage of specialists trained for the field, palliative care is no longer taking a back seat to more traditional healthcare. The majority of respondents to the Healthcare Intelligence Network’s first annual Palliative Care survey in February 2014 said they have a palliative care program in place, and of those that don’t, more than half said they planned to launch a program within 12 months.

Here are nine benchmarks gleaned from the 2014 Palliative Care survey:

  • Timely referrals of patients to palliative care are one of the biggest challenges to implementing a program, according to 89 percent of respondents.
  • Frailty is a key characteristic of their palliative patient/member population, say 48 percent of respondents; other traits include impaired cognitive capacity (34 percent) and disabilities (15 percent).
  • „„Candidates for palliative care are primarily identified by physician referrals (78 percent).
  • More than half (60 percent) of respondents said that case management assessments were important tools for identifying palliative care candidates.
  • While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • About 88 percent of respondents with palliative care programs reported an increase in patient satisfaction levels among Medicare participants, while 89 percent saw more satisfaction among caregivers.
  • Overall, the presence of palliative care helped to curb healthcare utilization costs for 70 percent of respondents.
  • Seventy-one percent of respondents with palliative care programs in place reported an uptick in hospice election by Medicare patients.
  • Nearly 20 percent of respondents said it was too early to tell what ROI their palliative care program generated.

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Excerpted from 2014 Healthcare Benchmarks: Palliative Care

Infographic: Few States Meet Palliative Care Benchmark

March 3rd, 2014 by Jackie Lyons

Only four states have effective strategies in place to improve access to and knowledge of palliative care services, according to the American Cancer Society Cancer Action Network.

State palliative care services are scored on a 0-6 scale, according to a new infographic from IMNG Medical Media. This infographic shows how each state scores on the scale, which combines grades from the Center to Advance Palliative Care’s national palliative care report card with actions on model legislation.

You may also be interested in this related resource: 2014 Healthcare Benchmarks: Palliative Care. Healthcare organizations need to be informed of new technologies and information sources. This 40-page report documents emerging trends in palliative care at more than 200 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience.


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HINfographic: Parsing Palliative Care and the Patient Experience

February 19th, 2014 by Jackie Lyons

While ‘palliative’ literally means to cloak or conceal, healthcare is taking the wraps off this critical service — in spite of provider resistance. A well-timed palliative care consult can enhance the patient experience and foster appropriate use of healthcare resources.

Seventy percent of healthcare organizations have a palliative care program, according to a new infographic from the Healthcare Intelligence Network. This HINfographic provides information on initial care consultations, Medicare metrics impacted by palliative care, palliative care teams, challenges of palliative care and more.

Parsing Palliative Care and the Patient Experience

 title= You may also be interested in this related resource: 2014 Healthcare Benchmarks: Palliative Care. This 40-page report documents emerging trends in palliative care at more than 200 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience — two critical markers of healthcare performance.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Healthcare Business Week in Review: Home Visits; Patient Portals; Health Insurance Marketplaces; Hospital Pricing

January 17th, 2014 by Cheryl Miller

There is no place like home visits to address safety issues, and patient care concerns. Despite the explosion of mobile and telehealth technologies, there is no substitute for person-to-person contact — at least when it comes to populations at high risk of hospital admission or readmission, the results of the Healthcare Intelligence Network’s inaugural Home Visits study indicate. Three-fourths of healthcare organizations visit some percentage of their patients or health plan members in their homes in order to keep patients safer and healthier and to keep readmissions and costly utilizers at bay.

But there is a time and place for telehealth technology, and new research in the journal Medical Care shows that diabetics who used an online patient portal to refill medications and schedule their appointments, among other tasks, increased their medication adherence and improved their cholesterol levels by 6 percent, compared to occasional users or non-users. Researchers say the current study provides new evidence that patient portals may help patients adhere to their medications and achieve improved health outcomes.

About one-quarter of Americans potentially eligible for health coverage visited insurance marketplaces by December, up from 17 percent in October, according to a new Commonwealth Fund survey. Forty percent of these visitors were young adults; three-quarters said they were in good health; and more than half said they are likely to try to enroll by the March 2014 deadline. The survey, conducted between December 11 and 29, 2013, is the second in a series aimed at tracking Americans’ experiences with the marketplaces in the ACA’s first open enrollment period. The first Commonwealth Fund survey, conducted in October, found that 17 percent of people potentially eligible for coverage had visited the marketplaces during the first month.

Despite increasing scrutiny on hospital pricing practices, some U.S. hospitals are charging more than 10 times their cost, or nearly $1200 for every $100 of their total costs, according to new data released by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP).

The 100 most expensive hospitals listed charge 765 percent and higher, more than double the national average of 331 percent, the report says. Fourteen U.S. hospitals charge more than $1,000 for every $100 of their total costs (a charge to cost ratio of 1,000 percent) topped by Meadowlands Hospital Medical Center in Secaucus, NJ, which has a charge-to-cost ratio of 1,192 percent. California, with a statewide average of 451 percent charge to cost ratio, ranks third overall in the United States. The detailed report includes the most expensive hospitals, the top 10 for each state, and the 50 most expensive hospital systems.

Discussions about end-of-life care for adults are never easy; they are even more difficult when they concern children. The National Institute of Nursing Research (NINR) has launched a new campaign, Palliative Care: Conversations Matter, that is designed to help children and families navigate a serious illness, and better inform them of supportive resources. A component of the National Institutes of Health (NIH), it brings together parents and palliative care clinicians, scientists, and professionals, who give their input and expertise on what they feel is needed in the field. Don’t miss the video which tells one mother’s story about her daughter’s bout with neuroblastoma and how palliative care helped them through it.

You can share your organization’s work in palliative care in our current e-survey: 10 Questions on Palliative Care. With more organizations focusing on palliative care as a means to enhance the patient experience during advanced or terminal illness, many are strategizing new ways to assess and address patients’ needs at this time, from consultations in the ED to face-to-face evaluations in outpatient clinics. Describe your organization’s efforts in palliative care by February 7, 2014 and you will receive a free summary of survey results once it is compiled.

Our congratulations to one of our survey participants, Timothy Price, a market research analyst with Caresource, who was randomly selected as the winner of our training DVD from our 10th annual Healthcare Trends & Forecasts webinar.

Early Palliative Care Improves Patient Care, Reduces Hospitalizations

January 15th, 2014 by Cheryl Miller

The word palliative literally means to cloak or conceal, and is used to describe care designed to alleviate the extreme pain and suffering of those with chronic or terminal illnesses.

It’s an ironic name for a subject many medical professionals would prefer be concealed. There’s a shortfall of as many as 18,000 board certified physicians focused on palliative care and hospice care in the United States. There are 5,150 hospice programs and 1,635 hospital palliative care teams in the United States, which means there’s only one specialist for every 20,000 older adults living with a severe chronic illness, according to the American Academy of Hospice and Palliative Medicine.

Certification roadblocks and lower salaries account for part of this shortage; but, it could also be chalked up to discomfort with the subject. According to a study from Massachusetts General Hospital, which surveyed over 4,000 physicians caring for cancer patients, researchers found that while the vast majority of them said they would personally enroll in a hospice program if they received a terminal cancer diagnosis, less than one-third said they would discuss hospice options with their cancer patients early in their diagnosis.

But new research, including the results to our current 10 question survey on palliative care, is showing that palliative care programs are increasing, and can improve the patient experience and help avoid costly hospitalizations. New York University College of Nursing researchers and colleagues reporting in the Journal of Palliative Medicine found that initiating a palliative care consult in the emergency department (ED) reduced hospital length-of-stay (LOS) by 3.6 days when compared to patients who received the palliative care consult after admission. The ED is a setting for triage, treatment, and determining the sick patient’s subsequent course of care, which in this case includes a dedicated palliative care unit.

“By providing early palliative care, patient needs are met earlier on, either preventing admission or reducing length of stay and treatment intensity for patients, which reduces costs to Medicare and the government,” says New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC. “Patients receiving palliative care are less likely to be readmitted as well. Early palliative care can better help patients to have their wishes met, and allow them to return to and stay at home.”

Helping people decide how they want to spend the rest of their lives, and granting their wishes might be the most important palliative care treatment of all. NPR reports on Dr. Tim Ihrig of Trinity Regional Medical Center in Fort Dodge, Iowa, who makes house calls to his patients nearing their end of life. “What are the three most important things to you,” he asks his patient, an 86 year-old wife, mother, grandmother, and great grandmother with congestive heart failure. She answers: “My girls, playing cards once a week, and counting money for the church once a month,” and he helps her to achieve that. Patients in palliative care at Trinity Regional Medical Center cost the healthcare system 70 percent less than other patients with similar diagnoses, hospital officials say.

And palliative care isn’t going away, in fact, it’s spurred a new HBO comedy series, Getting On. Taking place in an extended care facility, the short-staffed ward tries their best to tend to their patients — some of whom have Alzheimer’s disease, but most of whom are simply old &#151 while hoping they don’t lose their Medicare reimbursement. The series makes jokes about everything from displaced fecal matter to sex, attempting to make fun out of a subject that’s been cloaked, or concealed, for a long time. Whether the series is renewed remains to be seen, but at the very least it’s provided a look at the kindness a group of workers can give their patients nearing the end of their life.

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

June 22nd, 2012 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.

    Meet Healthcare Case Manager Sonia Morrison: Respect and Kindness Key to End of Life Care

    June 15th, 2012 by Cheryl Miller

    This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

    Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz

    HIN:Tell us a little about yourself.

    I am certified as a nurse case manager in oncology, and have worked in oncology for 21 years. I also worked in hospice for 11 years, was a certified nursing assistant (CNA) for three years, and a licensed vocational nurse (LVN) for one year.

    What was your first job out of college and how did you get into case management?

    I was in a junior college career ladder program, so I worked nights as a CNA in med-surg acute care and then in a licensed vocational nursing (LVN) registry, mostly in ob/gyn, prior to graduation. My first job was as an RN in the oncology med-surg unit at Salinas Valley Memorial Hospital (now Health Care System) or the SVMHCS, and I am still there.

    Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

    I thought I wanted to be a midwife when I started my nursing education, however, I did not like assisting births in the hospital with strangers. In my last year of working toward my associate degree in nursing (ADN), I met an amazing oncology instructor. At the same time, my best friend was dying of cancer, thus I became an oncology case manager.

    More recently, I taught a CNA program for several years. In mid 2011 I attended a life directions seminar and was able to harness all of my passions and focus them around caregiving.

    In brief, describe your organization.

    SVMHCS is an acute care hospital with an average census of 166.

    What are two or three important concepts or rules that you follow in case management?

  • The keys to successful utilization review and discharge planning and collaboration are communication, including written documentation and collaboration with the full team, including the patient, family, doctor, nursing staff and other providers.
  • Patients are assessed and educated within the first 24 to 48 hours of admissions.
  • Balanced self-care allows me to serve my team the best.
  • What is the single most successful thing that your organization is doing now?

    Expanding the role of case management to include p.m. shifts.

    Do you see a trend or path that you have to lock onto for 2012?

    Money talks and reimbursement has been the biggest challenge.

    What is the most satisfying thing about being a case manager?

    Treating patients and families with respect and kindness, especially at the end of life.

    What is the greatest challenge of case management, and how are you working to overcome this challenge?

    Finding services for obese or no pay source patients. SVMHCS case managers are working with management for creative sponsoring of needed services.

    What is the single most effective workflow, process, tool or form case managers are using today?

    Extended Care Information Network and executive health referrals.

    Where did you grow up?

    I was born in Los Angeles, CA, one of five girls and two surviving boys.

    What college did you attend? Is there a moment from that time that stands out?

    I attended Cabrillo Community College, Santa Cruz, CA for an advanced degree in nursing and a bachelor degree in public health nursing (PHN) at California State University at Dominguez Hills, CA. I enjoyed being of creative service in the community during my PHN clinicals; I used bilingual teaching tools to explain lab results, diet choices and I created new curriculum to introduce teens to human health by relating what they knew to horse health, disease, symptoms and interventions.

    Are you married? Do you have children?

    I have a husband of twelve years, a forty year old son and a six year old granddaughter.

    What is your favorite hobby and how did it develop in your life?

    The very first profession I fell in love with was a veterinarian, but my parents told me I was not smart enough to be a vet. So then I wanted to be a dancer, but my parents told me I couldn’t do that because if I broke my leg, I couldn’t support myself. So, now, I am a dancing nurse with six dogs!

    Is there a book you recently read or movie you saw that you would recommend?

    A book I wrote: The Heart of Caregiving, A Guide to Joyful Caring.

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