Advanced Illness Care Coordination in a Medicare Advantage Setting Richard Raskin, MD,FACP Chief Med - PowerPoint PPT Presentation

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Advanced Illness Care Coordination in a Medicare Advantage Setting Richard Raskin, MD,FACP Chief Med

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Angelina Yearick, JD, MSPH. Consultant to Health Services. White Plains, NY. Setting the Stage ... Medicare enrollees have high incidence of chronic disease ... – PowerPoint PPT presentation

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Title: Advanced Illness Care Coordination in a Medicare Advantage Setting Richard Raskin, MD,FACP Chief Med


1
Advanced Illness Care Coordination in a Medicare
Advantage Setting Richard Raskin, MD,FACPChief
Medical Officer, East DivisionAvon, CTDanielle
Butin, MPH,OTRDirector, Health Services, East
DivisionWhite Plains, NY Angelina Yearick, JD,
MSPHConsultant to Health ServicesWhite Plains,
NY
2
Setting the Stage
  • Medicare Advantage
  • Geography and Demographics
  • Population Selection
  • Health Risk Assessment
  • HCC Scoring
  • Claims Based/Predictive Modeling
  • Diagnoses

3
Rationale for Development of Program Targeted at
Medicare Advantage Enrollees
  • Medicare enrollees have high incidence of chronic
    disease and life-threatening illness
  • Clinical deterioration in these enrollees often
    occurs suddenly
  • Patients facing end-of-life decisions often do
    not have the requisite information to make
    informed choices about how they would like to
    spend their last days, and have not made these
    choices proactively.
  • As a result, coordination of care for enrollees
    at end-of-life is inadequate, leading to
    suboptimal qualitative and financial outcomes.

4
Advanced Illness and Coordinated Care Program
  • The Advanced Illness Coordinated Care (AICC)
    Program, developed by Dr. Dan Tobin, is designed
    to
  • Target enrollees with specific diagnoses for
    appropriate advanced care planning
  • Offer in home counseling to targeted enrollees.
  • Reduce the rate of patients dying in the hospital
    by providing patients the opportunity to spend
    the end-of-life in the setting of their choice
  • Empower these enrollees to become more proactive
    in the delivery of their end-of-life healthcare
    services.

5
Program Description
  • The program consists of a 3-month intervention of
    up to 6 in-home counseling visits, focusing upon
  • Relief of death anxiety (counseling component).
  • Informed decision making about therapeutic
    options and communication with surrogates, family
    members, caregivers and health care providers.
  • Identification of opportunities for improved care
    coordination.

6
Staffing/Training
  • No health plan staff is allocated full-time to
    this project.
  • Contracted/Outsourced Models for Care Delivery
  • Model 1 Nurse Practitioners credentialed as
    Independent Providers in AICC
  • 68 Trained providers in metro NY area to date
  • Model 2 Contracted Nurses and Social Workers
    through local Hospice Agency
  • 12 Trained Registered Nurses
  • 10 trained Social Workers
  • All staff training is conducted by Dr Dan Tobin
    at a full day intensive seminar.

7
AICC Visits (Targeted in Borough of Queens, NY)
  • Enrollee identified and mailed an introductory
    letter about the program.
  • Follow-up call within 1 week to invite enrollee
    to participate
  • Upon consent, AICC Provider assigned to conduct
    home visits

8
AICC Visits-What Happens at Home?
  • Meeting 1
  • Introduce goals of AICCP
  • How AICCP interacts with the primary care
    physician and the acute care team, and
  • What to expect.
  • Meeting 2
  • Evaluate capacity of caregiver
  • Discuss psychological, social, financial and
    practical concerns
  • Meeting 3
  • Forging the partnership of member and caregiver
    in AICCP care plan

9
AICC Visits What happens at home?
  • Meeting 4
  • Care management of functional impairment
  • DNR orders
  • Meeting 5
  • Obtaining feedback from providers on care plan
  • Working with family members on care plan
  • Meeting 6
  • Discuss accomplishments
  • Address remaining concerns

10
AICC Providers-Need Back-Up
  • Coordination of services provided by Education
    Outreach Department
  • Additional service requests were made by
    practitioners for
  • Home health care
  • Nutrition consultations
  • Prescription assistance
  • Meals on wheels
  • Transportation services
  • DME
  • Custodial care

11
AICC Visit Tracking
Utilize 5 forms for data collection
  • Palliative Care (4)
  • Spiritual/Religious Issues (4)
  • Life-sustaining treatment (5)
  • Psychological and other concerns (5)
  • Bereavement needs (5)
  • Life closure (5)
  • CUP Profile (1-5)
  • Curative, Uncertain, Palliative
  • Pain Assessment (1-5)
  • Coping with diagnosis (1)
  • Psychological Status (2)
  • Advance Directives (2)
  • Quality of Life (2)
  • Practical Issues (3)
  • Family Concerns (3)

12
Demographics of Population
13
Diagnoses of Population
  • Main Diagnoses for Selection on hospitalization
    and predictive modeling
  • CHF
  • COPD
  • Metastatic Cancer
  • Some additional diagnosis were added in
    predictive modeling
  • Alzheimers disease
  • Stroke

14
Enrollment in Program By Number of Visits
15
Adherence with Advance Directives
  • National prevalence of advance directives 15-20
  • Compliance with Advance Directives in Program

16
Selection of Health Care Proxy
17
Financial Results of Program
18
Current Status of AICC Participants
19
Mortality Data
  • Nationally, about 80 die in hospital or facility
  • 9.3 of enrollees died within 18 months
  • 41 died in the hospital
  • 58 died at home, in a snf or with hospice
  • Of those who died, the average lifespan was 6
    months after start date

20
Interpretation of Data
  • Impact of Number of Visits on Outcome
  • Impact of AICC Provider-2 Models
  • Utilization of Palliative Care/Hospice Services
  • Medical Utilization Impact

21
Conclusions
  • AICC can be an effective strategy to improve end
    of life care within a Medicare Advantage
    population.
  • Program success requires careful enrollee
    selection.
  • Nurses and nurse practitioners are effective AICC
    providers
  • AICC Providers with case management expertise are
    more successful at sustaining member enrollment
    and achieving positive outcomes.
  • Collaboration between hospice organizations and
    Medicare Advantage health plans has the potential
    for improving hospice utilization and clinical
    outcomes.
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