Palliative Illness Management™ – at home

Access to care for seriously ill patients and their caregivers who are living at home and struggling with multiple issues on a daily basis.

Market Challenges

Patients with serious illness often require more intensive medical services coordinated across multiple providers, as well as a wide range of social supports to maintain health and functioning.

Health plans often lack a consistent, structured process for scaling this type of solution across their member populations and geographies. They seek a systemized solution that seamlessly integrates with existing case and utilization management programs to further optimize the consistency of care and the overall care experience.

Nursing in home

A Commonwealth Fund survey of patients with complex needs demonstrates the urgent need to apply innovative approaches to management of this population:

  • Hospital readmissions

    47% visited the emergency department multiple times in the past two years

  • Improve Care Transitions Post Acute Care

    Over 50% did not have access to services to help manage their conditions

  • Paid Parental Leave CareCentrix

    62% experienced stress about their ability to afford housing, utilities, or nutritious meals

Patient-Focused, Home-Based Palliative Care

Turn-Key Health’s Palliative Illness Management™ (PIM™)

Structured, Consistent Approach to Home-Based Palliative Care

A home-based palliative care model, the PIM™ program serves health plans, provider organizations and their members who are experiencing a serious illness. Complementing the CareCentrix post-acute care model, PIM identifies, engages and improves the member and caregiver quality of life, reduces over-medicalization and lowers cost.

Systemized and Process-Driven

The PIM program utilizes predictive analytics for member identification and prioritizes the importance of home-based care, arranges appropriate services to address Social Determinants of Health (SDoH), provides clinical assessments / referrals, and partners with physicians to deliver a patient-centered, data-driven, and evidence-based solution.

  • Member Identification:The PIM program identifies members likely to experience over-medicalized care or death. In conjunction with the CareCentrix PAC program, it provides the benefit of holistic evaluation, leveraging evidence-based tools to assess for palliative appropriateness in real-time, bridging claims lag.
  • Member Engagement: A network of PIM clinicians provide support through telephonic outreach and home visits. They conduct member engagement to provide home-based support including symptom monitoring, medication reconciliation, psychosocial / spiritual support, and documentation of advance care plans.
  • Provider Engagement: Extending the reach of physician practices and the medical home, the PIM model provides practical support that complements and enhances care management. It seamlessly integrates with existing case and utilization management programs to further optimize the overall care experience.
  • Quality Control & Reporting: Clinical teams are guided by the PIM platform tools and assessments. This includes a proprietary Palliative Activation Scale (PAS), designed to optimize patient and caregiver engagement. The CareCentrix suite of reports provides ongoing insights into key clinical, operational and financial outcomes.
Man with nurse

Overcoming the Burdens of Serious Illness

Proven Return on Quality Improvement & Resource Investment

  • Patient satisfaction

    Identifies members earlier

    • Identifies members earlier in their disease progression who could benefit from home-based palliative care
  • Paid Parental Leave CareCentrix

    Supports the medical home

    • Supports the medical home, a first-hand window into the member’s home to understand the breadth of challenges
  • Enhances member engagement

    • Enhances member engagement with clinicians who facilitate conversations and align goals of care with treatment preferences
  • Savings Home Health

    Reduces costs

    • Reduces costs by optimizing pre- and post-acute care, reduces hospitalizations, ED visits, readmissions and number of ICU days

FAQs

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