• Demonstrate their commitment to members with a serious oradvanced illness
  • Assess their programs for palliative care
  • Evaluate the value that they bring to your customers
  • Determine the effectiveness of their focus on deliveringquality care while balancing cost

Escalating costs for payers

will quadruple5 percent of beneficiaries in their last year ofliferecent study

  • 48.7 percent (nearly half) of older Medicarebeneficiaries were classified as “high persistent,” maintaininghigh spending throughout the year;
  • 10.2 percent showed a “progressive” pattern,starting low but increasing steeply;
  • 29.0 percent of decedents were “moderatepersistent,” mimicking the “high persistent” pattern except for aspending dip a few months prior to death;
  • 12.1 percent of the sample exhibited a“late rise” in the final four months of life after very lowspending in the earlier months of that finalyear.

Palliative care benefits payers and members

NewEngland Journal of Medicinenearly threemonths longerNational Center forBiotechnology Information

  • Focuses on care coordination across all settings
  • Emphasizes ongoing support at home
  • Ensures advance care planning
  • Engages physicians and other care providers
  • Provides integrated, dedicated, interdisciplinary, team-basedcare
  • Establishes goals of care
  • Addresses needs of those who are ineligible or those who refusehospice
  • Identifies gaps in care
  • Provides pain and symptom relief
  • Facilitates disease understanding and self-management
  • Offers psycho-social support
  • Primary and secondary diagnoses
  • Medical and hospitalization/ED history
  • Functional status and activities of daily living
  • Symptom assessment
  • Medication review; adherence assessment
  • Adequacy of home, family, safety and financial supports
  • Patient's understanding of illness
  • Goals of care/Advance Care Planning
  • Services in place or needed
  • Patient risk evaluation
  • Palliative Plan of Care

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