palliative care for medicare advantage cancer patients: patient ...€¦ · hospice pcp declined...
TRANSCRIPT
YTD Total Eligible (Denominator) 218YTD New Touches (Numerator) 96% YTD Eligible 44%
YTD Ineligible 97% YTD Ineligible 31%
San Antonio YTD Total Yield 315
Brevard
Martin
St. Lucie
Indian River
Lake
Marion
Osceola
Volusia
Orange
SumterSeminole
Polk
Pasco
Hillsborough
Hernando
Pinellas
Hardee
Highlands
Miami-Dade
Broward
Brevard
Martin
St. Lucie
Indian River
Lake
Marion
Osceola
Volusia
Orange
SumterSeminole
Polk
Pasco
Hillsborough
Hernando
Pinellas
Hardee
Highlands
Miami-Dade
Broward
FLORIDA
Hays
Travis
Williamson
Aransas
Kleberg
Nueces
San Patricio
Collin
Dallas
Denton
Ellis
Kaufman
Rockwall
El Paso
Johnson
Parker Tarrant
Cameron
HidalgoWillacy
Atascosa
Bexar
Comal
Guadalupe
Kendall
Wilson
TEX AS
315 Total Patients
218Eligible
97Ineligible
96New Touches
(of the 44% enrolled)
% Patients enrolled in the following servicesPalliative Care
Bridges
Hospice
PCP
Declined Services
56%123 not enrolled
44%96 new touches
34% 22%
8%
30%6%
Palliative Care for Medicare Advantage Cancer Patients: Patient Selection and
Preliminary Results
• Messaging to patients and oncologists
• Geography (large catchment areas)
• Staffing
• Education/training for staff in oncology specific needs
• Data collection/management
AUTHOR:Leigh Fredholm, MDLinda May, MD
WellMed is a healthcare delivery network serving more than 370,000
seniors in Texas and Florida via contracted Medicare Advantage health
plans. The WellMed Palliative Care program serves patients across
multiple settings: inpatient, post-acute, home and clinic. As the Palliative
Care program grows, we continue to seek novel methods to identify
eligible patients earlier in their disease trajectory. Members with oncologic
diagnoses are cared for in multiple and diverse settings, often with high
symptom burden and potentially avoidable gaps in care, making earlier
identification of eligible patients a priority for our program.
In December 2017, we began testing methods for upstream identification
of oncology patients with high mortality diagnoses. Methods tested
include insurance claims and prior authorization requests. Over the first
quarter of 2018, identified patients were offered Palliative Care in our
Austin and San Antonio programs. Notably, this methodology identified
unique patients that had not been identified with other algorithmic
approaches. As results were encouraging, the pilot was expanded to
seven additional cities in second quarter 2018. All patients are offered
a visit with a specialist Palliative Care clinician. After full assessment,
patients may be enrolled in our home based program or specialist clinic;
or return to their primary care physician if no needs are identified. We will
share our experiences in the pilot and expansion phase, including rates
of advance care planning, improvement in symptom burden and earlier
hospice enrollment.
D E S C R I P T I O N
Identification of high burden cancer patients-monthly reports
•Claims based: new claims for pancreas, liver, gastric, lung, brain and metastatic disease
• Authorization based: new authorization requests for PET scans
Lists are reviewed and processed
• Chart review where available
• Remove patients from list who: Moved out of service area Changed insurance/physicians Enrolled in hospice
Deceased
Remaining patients are offered specialist Palliative Care visit
Patients are evaluated and enrolled as appropriate
• Palliative Care Clinic: intermittent provider visits • Bridges (home based Palliative Care) Home visits by MD/NP, RN, SW Frequency of visits titrated to patient need, may be weekly
METHODS
Addressing the Needs of Specific Patient Populations
BARRIERS/CHALLENGES
• Add additional diagnoses for 2019
• Educational curriculum for program staff
FUTURE EXPANSION
A. El Paso
B. Fort Worth
C. Dallas
D. Austin
E. Corpus Christi
F. Rio Grande Valley
G. San Antonio
A. Greater Tampa
B. Greater Orlando
C. Treasure Coast
D. South Florida
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B.
C.
D.
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B.
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F. E.
OCTOBER | 2018. Confidential property of WellMed. Do not distribute or reproduce without express permission from WellMed.