When George Schwartz’s late wife was diagnosed with advanced lung cancer in 2002, he faced the task of managing her care while working as a financial advisor in a small brokerage firm.

He accompanied her to appointments, researched treatment options, coordinated her care and struggled to manage the fears that came with the dire diagnosis.

The experience was both physically and emotionally draining. It wasn’t until the couple turned to palliative medicine, a fairly new subspecialty recognized by the American Board of Medical Specialties in 2007 that helps patients manage serious illnesses, that the load became bearable, he recalled.

 

“It provided us relief from anxiety, starting with a clear explanation of the course of the disease, what end of life would be like and how a palliative care doctor would deal with her deteriorating health,” said Schwartz, 66, whose firm, Gilbert, Doniger & Co., is based in New York. “I had a lot of interaction with the health care system and I hadn’t heard of it. My wife found out about it in a magazine article.”Palliative medicine, which is practiced by specially trained doctors, nurses and other health care professionals, provides care for patients with life-limiting conditions such as cancer, advanced heart disease, dementia, and kidney failure, among others. The goal of palliative care is to improve quality of life through pain management, stress relief, treatment for fatigue and depression, and by offering support for caregivers.

It is also associated with lower health care costs and better outcomes for patients and their caregivers, who are vulnerable to stress and illness, according to Lea Tessitore, a researcher with Catalyst for Payment Reform, a nonprofit organization that works on behalf of large employers.

“Cost savings can come in a variety of ways,” she said. “If you lead with a focus on quality of life then cost reductions will follow. For example, having a conversation around the goals of care with a provider can help to avoid aggressive and potentially harmful treatment that isn’t necessary.”

In September, CPR and the Center to Advance Palliative Care released a guide to help employers develop a palliative care strategy and educate them on what it is and how it can help patients and caregivers. Tessitore said that it could also help employers approach a topic that can be difficult to talk about.

“Many people think that palliative care is synonymous with hospice care and that creates a barrier to having these conversations,” she said. “They think that this is the type of care I get when I’m ready to give up. But palliative care is a high-value way to make an impact on the lives of employees with serious illness and their caregivers. It can improve the quality of life and it can reduce costs.”

Also read: Organ Transplant Innovations Can Save Health Care Dollars

It is associated with shorter hospital stays and lower health care costs due to a decreased need for 911 calls, emergency room visits, hospitalizations and the elimination of costly and ineffective treatments. In fact, patients with serious illnesses who received palliative care saved an average of $3,237 over the course of a hospital stay compared to patients who did not receive it, according to a study published in JAMA Internal Medicine in 2018.

These costs savings are catching the eye of employers, who recognize that while just a small fraction of employees have serious illnesses, most of their health care dollars are going toward their treatment, according to Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

“About 2 percent of the commercial population is facing a serious illness and the care they get is often unnecessary. … That percentage sounds tiny but it’s where employers are spending most of their money.”

One employer who recognized the costly gaps in care for seriously ill patients is Dow Chemical, which worked with insurance giant Aetna to launch a hospice program in 2004 that allows patients to pursue treatment through palliative care. Typically, insurers will not cover hospice care if the patient continues to seek “curative treatment,” said Silvers. This forces patients to choose between palliative care and hospice, which focuses on the needs of the terminally ill. Dow is featured in the CPR toolkit.

She hopes that more employers will see the potential of palliative care to improve the lives of employees with serious illnesses.

“We really want purchasers to demand from their health plans that they make palliative care available to participants,” she said. “We’re hoping to drive demand. It’s not a hard thing for health plans to do, but they don’t have much impetus. Employers need to demand this.” 

The post Employers See Palliative Care as Option to Cut Health Costs appeared first on Workforce.

https://www.workforce.com/2019/01/11/employers-palliative-care-option-cut-health-costs/

Health care is costly. That’s nothing new.

Consider this: The average annual cost of health care has increased from $146 per person in 1960 to more than $10,000 per person in 2016, and care costs are expected to increase by six percent in 2019. So, while offering high-quality health care is a great way to take care of your employees, it’s becoming increasingly difficult to juggle the cost of their care with your company’s bottom line.

An option that’s become more available in recent years is the value-based health plan. In value-based health plans, payors share data and analysis to help providers improve their patient care outcomes. Through enhanced reporting and collaboration, doctors can identify areas to gain efficiencies, reduce unnecessary care, and most importantly, improve patient satisfaction and health.

Then, providers earn additional reimbursement based on their performance on cost, quality and outcomes measures. In value-based payment arrangements, health plans pay doctors more for improved patient outcomes and higher quality, and the total cost of care is better controlled.

Many companies are moving away from traditional fee-for-service agreements and toward these value-based payment arrangements. According to an analysis, the number of available alternative payment plans grew from 67 in 2011 to 823 in 2017.

Value-based payment arrangements get to the heart of the major drivers of health costs — hospital stays, ER visits, over treatment and chronic conditions like diabetes. So, when patients get the care they need at the right time, in the right setting, they have fewer complications, and require fewer hospital stays, ER visits and readmissions. These improvements help reduce costs paid by employers and insured members.

Nationally, the Michigan Blue Cross plan shares data and analysis with other Blue plans across the United States, so they can not only measure performance on a national scale, but use the data to create tailored, value-based health plans for companies with employees in multiple states.

For example, value-based Blue plans nationally have shown a 10 percent decline in ER visits, 2 percent decline in hospital stays, and an increase in prevention and chronic care management.

When it’s time for companies to decide on health plans for their employees, they should first ask their health plan some important questions.

1. Are value-based plans available where you have employees? Does your plan have enough value-based providers and programs to benefit your team? Make sure to check the geographic distribution and depth of services available, so your employees can realistically use the services of these value-based providers.
2. How long has your plan’s value-based program been in place? Find out if the program is mature, and whether they have a measurable trend in value. Programs that are older or more established typically have data that demonstrates the results they’ve been able to achieve.
3. Do the health plan and its providers collaborate? This will show whether they understand the local dynamics, and whether the plan supports the providers in achieving improved performance.
4. How extensive is the plan’s member base and value-based network? The larger the plan, the greater its ability to share meaningful data and influence care delivery practices.
5. Does the plan offer flexible options? A one-size-fits-all approach to value-based networks doesn’t necessarily fit the unique needs of your employee base. Take some time to ask your plan how it measures provider performance and how it rewards members for choosing high-performing providers.

Value-based payment arrangements and value-based network design are two trends that have been demonstrating results for companies. Health care is costly. But now, there are strategies that help companies manage health costs while improving health care for employees.

Also read: Performing a Check-up on Value-based Health Care

The post Value-Based Care: Making Health Plans Work Better appeared first on Workforce.

https://www.workforce.com/2019/01/04/value-based-care-health-plans-better/