Download Palliative Care

Outpatient Home
Based Palliative
Care
A PILOT PROGRAM OF HOSPICE OF CANADA
PAYOR PRESENTATION
Summary of Need
Need for home based palliative care far outweighs current
capacity in both California and Canada County
◦ California County – 29% need/ 6% capacity
◦ Canada County -- 29% need/ 0% current capacity 1
Currently one palliative care provider in the county
Access to services limited by payor/provider
http://www.chcf.org/publications/2015/02/palliative-care-data
1. .Mapping Palliative Care Need in California, Kathleen Kerr and Kate Myers, 2014
PAYOR PRESENTATION
Why A Pilot Project?
Prepare organization for a large scale implementation
Allow us to test assumptions
Gather data and provide evidence to secure additional
funding
Identify challenges and mitigate risk early
Prepare team for a more demanding program/growth
Develop systems to communicate with physicians and
community referral sources
PAYOR PRESENTATION
Initial Plan
Year 1 Allocate $$ to develop a pilot program. Scope and
model to be determined (approx. $450,000)
◦ Training, education and implementation
◦ Gather and analyze data
◦ Develop Community and Payor support
Year 2 Evaluate data and Plan Future Project
◦
◦
◦
◦
Identify Trends
Estimate Need
Determine costs to grow/expand
Plan larger scale deployment
PAYOR PRESENTATION
$450,000 – A good start
1.0 FTE MSW (approx. $100,000)
Add 1.0 FTE nursing ($90,000)
Add .8 FTE Nurse Practitioner ($120,000)
Add .20 FTE Medical Director ($50,000)
Add 1.0 FTE Palliative Care Coordinator ($50,000)
Additional expenses include marketing materials, business
development activities, education and training, professional
membership and consultation services (as needed).
PAYOR PRESENTATION
Tentative Budget
Palliative Care Pilot Budget FY15/16
Annual Run
143,750
137,500
156,250
62,500
62,500
Program Manager
Add 1.0 tele nursing
Add 1.0 NP
Add .20 MD
Add 1.0 Palliative Care Coordinator
Marketing materials, business development activity
CAPC Membership
Conferences/Trainings
Legal and Insurance
Total incremental projected spend in FY 15/16
PAYOR PRESENTATION
10,000
3,500
10,000
10,000
596,000
FY 15/16
45,000
68,750
91,146
46,875
36,458
20,000
3,500
10,000
15,000
336,729
Palliative Care for 75 patients
Provide Care to 75 patients over the course of 1 year
(prognosis 1 year or less)
Includes patients at (one) Skilled Nursing Facility
Patients will transfer to hospice when prepared and eligible
Average Length of Stay (ALOS) in outpatient palliative care
can range from 1 month- 1 year but transfer to hospice
within months is typical
Define metrics and establish a baseline to improve
outcomes and reduce unnecessary utilization of emergency
medical services and/or hospitalizations
PAYOR PRESENTATION
Collaboration with Attending Physician
While on Palliative Care services, the patient's Attending
Physician (AP) will continue as the primary physician
directing the patient's care
The Palliative Care Medical Director serves as a consultant
supporting the Attending Physician's treatment plan
Collaboration with the AP for suggested changes in
medications or symptom management
The Palliative Care Team supports and assists the AP by
providing additional care, support and oversight to their
palliative patients
PAYOR PRESENTATION
Payment Models
PER MEMBER PER MONTH (PMPM)
A fixed fee intended to cover
all palliative care services
provided to a member
meeting eligibility criteria
PAY FOR PERFORMANCE/OUTCOME
INCENTIVES
A lower fixed fee per month
Incentive payments based on
achievement of
predetermined metrics
(decrease in acute days)
Palliative Care Services can
lower the cost of care for the Example: $700/mo. fixed fee
and $250/mo. incentive
network
payment per member for no
Example: $1200/mo.
hospitalization
PAYOR PRESENTATION
Update: Final Model
Contract initiated with physician payor group
$1000 per patient per month for 6 months of pilot
$700 per patient per month after 6 months
Incentives TBD
Assigned an RN Case Manager
Monthly Care Coordination Meetings
PAYOR PRESENTATION