mehl - thinking out of the box - leadingage washington · thinking out of the box: the pace program...
TRANSCRIPT
THINKING OUT OF THE BOX:
The Pace Program as a Model for Outpatient Palliative Care
Presented by: Stephanie Mehl RN, MS
Corina Kroll
Objectives
Explain the value of palliative care and its contribution to the continuum of care for seniors.
Describe the Providence Elderplace Pace Program, eligibility criteria, the unique services offered, the positive health outcomes and how it can viewed as a palliative care model
Imagine new palliative care partnerships for the future
What is Palliative Care???
Defining Palliative Care
Specialized medical care for people with serious illnesses. Focused on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.
Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Center to Advance Palliative Care, 2011
Defining Palliative Care
A philosophy of care• Prevent and relieve suffering• Quality of life • Personal growth
An organized, highly structured care model• Enhancement to disease-based treatment• Assist with decision making• Offered in conjunction with life prolonging treatment, or
as main focus of care
nationalconsensusproject.org
N=151; 77 in PC arm: with improved QOL, fewer depressive symptoms, and patients lived 30% longer [11.6 vs. 8.9 months] despite less “aggressive” care.
Temel. NEJM. 2010;363(8):733-742.
Hospitals now get it
The most visionary and practical hospitals are taking action. Over the past five years, the number of academic, community and faith-based hospitals offering palliative care services has soared.
As of 2009, some 1,568, or 63 percent, of U.S. hospitals with more than 50 beds had a palliative care team—an increase of 138.3 percent since 2000. Palliative care teams are now the rule, not the exception.
Home Based Care /Community Based Programs
Provider home visits (billable Part B)
Home care services
Bridge programs (pre-hospice services)
Case management; disease management
Transitions coaches
Choice and design depend on needs assessment and goals
Community Based Program Barriers
Funding hurdles Different models Lack of resources Lack of research
Providence Palliative Care Projects and Programs
Partners Program Transitions Oregon Programs Premera Demonstration Project Elderplace
PACE
14
Program of All-inclusive Care for the Elderly
o Philosophy: Coordinate financing and care to improve outcomes and quality of life, preserve dignity and lower costs all with a goal of keeping elders at home in their communities
o Dual Capitation Funding:• Medicare• Medicaid
Capitation places PACE at full financial risk
How does PACE work?
15
Integrates Medicare and Medicaid service delivery at provider level:
Acute inpatient, emergency department & specialty Skilled nursing, Outpatient, home health & home care, Residential: Adult Family Home & Assisted Living Facility, Best practice preventive care, Behavioral health, Palliative care and hospice
Services include: pharmacy, rehab and other ancillary services, DME, and transportation
Care is highly coordinated and managed by a geriatrician-led interdisciplinary team (IDT)
The role of the PCP and the IDT are key to quality & care management
• Physician – geriatrician (FP or IM) &/or ARNP
• RN• MSW• Physical Therapist (and PT
assistant)• Occupational Therapist• Recreation Therapist• Registered Dietician• Personal Care Attendant
(NA-C, IP, NA-R)• Driver• Others…
Residential Setting
Snapshot of 437 PEPS participants (3/1/13)
Largest population – 421 - are in community-based settings 149 (34%) are in adult family homes 170 (39%) are in assisted living facilities 102 (23%) are in other home settings
Residing in community-based settings is possible as a result of extensive PACE “wrap-around” services
NOTE: Only 2 (0.4%) were in the hospital
PEPS Participant Characteristics -2012• Average age: 78.5 years
• Male 35%; Female 65%
• Race: • Caucasian 69%
• African American 18%
• Asian, Native American & Other 13%
• 52% dependent in 5-6 ADLs
• High chronic disease burden: average 9
• Average # prescription meds 8
Chronic Disease Burden Dementia 59% Chronic mental health 50% Diabetes + 35% Chronic lung disease 31% Stroke 29% CHF 24% Cancer 12%
18
PEPS Outcomes – 2012
19
o Hospital LOS• PEPS = 3 days vs. Medicare = 5.6 days
o Readmissions within 30 days • PEPS = 12.8%
• Medicare = 20%• Medicaid residing in SNF = 23%
20
Better Planning through Advance Directives o PEPS has 90% POLST completion rate within 3 mo. compared to:
o Older adults 10-30% complete advance directiveso SNF residents 45-78% complete advance directives
Living Longer and Dying at Homeo Less than 15% of PEPS participants die in hospital or SNFo Medicare annual mortality 28% for those impaired in 6 ADLs
compared to 16% of PEPS participants impaired in 6 ADLso 21 PEPS participants are currently receiving palliative care services
PACE End of Life Care
Trained home-care team for EOL PHOS Partnership
For afterhours and weekends
Outcomes
PACE National Duals
Hospital Re-admission rate (within 30d) 12.8% 20%
Mortality (of those with impairment in 6+ ADLs)
16% 28%
Location of Death: Hospital or Nursing Facility
14% 54-66%*
% with an Advance Directive and/or POLST
90% 10-30%**
*JAMA Network studies**Multiple studies find 10-30% of Medicare beneficiaries have Advance Directive.45-78% of nursing facility residents have advance directive depending on State.
Quality Care Leads to Longer Life Expectancy
“PACE clients have a significantly lower risk of dying, compared to similar clients who receive care in other home and community based service (HCBS) modalities. In the first 12 months after enrollment only 13 percent of PACE clients died, compared to 19 percent of HCBS clients. By year three, 29 percent of PACE enrollees had died, compared to 45 percent of HCBS clients”.
Source: Mancuso, D., Yamashiro, G., Felver, B. PACE An Evaluation, Washington State Department of Social and Health Services Research & Data Division, Report Number 8.26, June 29, 2005.
What’s in it for the client?
24 hour a day MD on call IDT focuses on management of the whole person No co-pays IDT follows the client in every care setting, including end-of-life Access to some benefits not covered elsewhere Transportation to medical appointments & to the Center for
social activities
What’s in it for the client?
Palliative Care Outcomes Quality of life improvement Less hospitalization Longer hospice care/reduced mortality Cost savings
People want:
More time with their health care providers A voice in their care Ongoing communication Vigorous pain and symptom management Relief from worry, anxiety and depression Well coordinated care and transitions Support for family caregivers Sense of safety in the health care system
House Bill 1499
HB1499 –requires all eligible COPES beneficiaries be referred by their HCS or ADS case manager to PACE.
The beneficiaries DO NOT HAVE to choose PACE and are NOT automatically enrolled.
The legislation requires case managers to give EVERYONE the option.
The legislation allows for deemed status for participants already enrolled in PACE – an annual re-assessment will no longer be required to determine eligibility.
Future Trends
Moving the focus of care from the hospital to the home and community can be achieved with integrated care and can be facilitated by changes in government policy
Partnerships and imaginative thinking
Partners in Palliative Care
Center for the Advancement of Palliative Care (CAPC) CAPC a national organization dedicated to increasing the availability of
quality palliative care services for people facing serious illness.
CAPC provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.
www.capc.org• National Palliative Care RegistryTM
• Palliative Care Leadership CentersTM
Training and Mentoring
• The IPAL-ICU Project: Improving Palliative Care in the ICU
• CAPC Campus OnlineTM
• Audio-Conferences and Webinars
• CAPCconnectTM Online Discussion Forum
• Tools, Toolkits and Crosswalks
• State-by-State Report Card
• www.getpalliativecare.org for Patients and Families
• Annual National Seminar
• Expert faculty, consultants and staff to answer your questions
For more information regarding Providence PACE and Palliative Care Programs:Corina Kroll, Marketing & Referral [email protected]
Susan Tuller, Executive [email protected]
Stephanie Mehl (PHOS), Clinical Educator/[email protected]