Palliative Care for Medicare Advantage Cancer Patients: Patient ...€¦ · Hospice PCP Declined...

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

A.

B.

C.

D.

A.

B.

C.

D.

G.

F. E.

OCTOBER | 2018. Confidential property of WellMed. Do not distribute or reproduce without express permission from WellMed.