Community Based Advanced Illness Care: Good for Patients; Good for Payers

Outcomes 1. Utilizing a patient case to demonstrate the model experience, participants will self-report the opportunities in developing PMPM programs with MA organizations.2. Participants will be able to apply key strategies that allow for early symptom management through crisis plan development which can lead to decrease in acute healthcare utilization. Key Message Community Based Palliative Care (CBPC) programs can partner with Medicare Advantage (MA) Organizations to serve patients with advanced illnesses to increase delivery of goal concordant care, increase quality of life and decrease overall costs. Through appropriate identification of high-risk patients and Per Member Per Month (PMPM) reimbursement, community-based programs can be financially supported and serve as an answer to payers. Context CBPC programs often find it difficult to be financially sustainable in a fee for service (FFS) healthcare environment. Medicare Advantage Organizations are taking on financial risk with regards to a medically fragile patient population that are high utilizers of acute healthcare. We developed an Advanced Illness Care (AIC) program and in partnership with a local healthcare system and MA organization receive PMPM reimbursement to deliver high quality interdisciplinary palliative care to patients wherever they call home. The AIC team focuses on expert symptom management, early goals of care discussion and completion of advance directives and provides 24/7 support with the development of crisis plans to help reduce acute symptoms that could lead to an ED visit. Through AIC, patients have reported a high degree of satisfaction with their care, improved quality of life and we have reduced inpatient spending by over 50% in comparing patient's pre-enrollment and post-enrollment. Objective 1 Utilizing a patient case to demonstrate the model experience, participants will self-report the opportunities in developing PMPM programs with MA organizations. Objective 2 Participants will be able to apply key strategies that allow for early symptom management through crisis plan development which can lead to decrease in acute healthcare utilization. Case Review An 80-year-old with AIC primary diagnosis of COPD was admitted. He received full interdisciplinary team support and utilized crisis plans 5 times preventing ED visits. With worsening disease, he transitioned to hospice, receiving services for 9 months. Our AIC program was reimbursed monthly. Conclusions Our Advanced Illness Care model, with PMPM reimbursement allows for the delivery of high-quality palliative care to a high-risk patient population while remaining financially sustainable. Strategies for crisis prevention led to decreased acute healthcare utilization and thereby reducing overall costs. Patients report an overall improvement in their quality of life through this program. Keywords Models of Palliative Care Delivery; Patient Outcomes