How Carelon Health’s Palliative Care services improves patient outcomes and provides value-based care
What is palliative care?
Palliative care improves patients’ quality of life as they face physical, psychological, social, emotional challenges related to serious illness, terminal diagnoses, or end of life stages. Effective palliative care prioritizes the needs of patients’ families and caregivers, in turn improving the quality of their lives as well.
Optimal palliative care is patient centered and cost effective. In a value-based palliative care model, providers strive for results based on patient health outcomes rather than the number of services they deliver, often leading to improved patient survival rates.
How palliative care differs from other healthcare services
Palliative care encompasses more than end-of-life care, as services include specialized medical care for patients with serious medical illnesses, focusing on relief from symptoms, pain, and the psychological distress associated with serious illness. Care prioritizes the prevention, early identification, assessment, and management of physical issues.
“Palliative care provides patients with an extra layer of services, which is especially important to those who are facing serious illness. These services provide the patient and their families comfort, support, and discussions regarding the patient’s healthcare goals, including advance care planning. Palliative care is for the patient’s life journey, not just their end-of-life stage. Palliative care helps to relieve a patient’s suffering at all their life stages,” says Simeon Kwan, DO, West Region Medical Officer, Carelon Health Palliative Care.
How Carelon Health Palliative Care services benefits patients
Carelon Health provides community-based palliative care services, working with patients in a variety of living arrangements, including the patients’ own homes, independent living, or senior living, offering 24-hour access that minimizes any potential gaps in patient care. Community-based programs provide care outside of a hospital and focus on delivering palliative care through a network of a collaborative providers.
Carelon Health’s team of providers triage the patients’ needs systematically. “We provide interdisciplinary teams, nursing, and social work, that wrap around patient,” says Dr. Kwan. “We also have proprietary algorithms that look through health care claims, proactively identifying patients that might be able to use our services, so that we can offer patients effective, early palliative care.”
Carelon Health addresses patients’ priorities according to Maslow’s hierarchy of needs. “Our first priority is to focus on the patient’s physical symptoms, such as shortness of breath, delirium, and pain. After we stabilize those issues, we then focus on the patient’s psychosocial concerns and mental health,” says Dr. Kwan. “We then work with the patient and their family on advance care planning and their goals. We support the patient as they learn to cope, and how they want this next part of their life to progress.”
How Carelon Health’s palliative services contributes to health care cost savings
Dr. Kwan notes how Carelon Health’s palliative services contributes to value-based care, as studies indicate that palliative care can reduce health care costs by an average of $4,000 per patient. “We wrap patients within our support team services, which addresses patients’ needs as they arise. This helps to reduce ER use and hospital visits.”
Early delivery of palliative care also reduces unnecessary hospital admissions and the use of health services, in turn reducing the costs of care. “Our services help to reduce costs by facilitating earlier hospice transitions. Patients can fully utilize the benefits of hospice, avoiding the discomfort and costs associated with terminal hospital stays.”
How health plans can effectively integrate Carelon Health’s Palliative Care services into their healthcare offerings
Dr. Kwan emphasizes how Carelon’s services enable patients to interact with multiple entities, which helps to coordinate patient care effectively and efficiently, with clear communication. “We partner with the patient’s primary care providers and specialists. We show the patient how to advocate for themselves. We also coordinate with the patient when they leave the hospital so that they receive timely aftercare. We know when the patient is in an acute facility and know when they return.”
How Carelon Health ensures healthcare access for all eligible patients
Dr. Kwan highlights Carelon Health’s mission to provide care access for patients from a wide variety of backgrounds, meeting them where they are, at different economic levels. “Accessibility is a major benefit we offer to patients, regardless of their income level, or background. To further ensure access, we also offer care options via telehealth.”
Carelon’s palliative care services offer more than just end of life care. “Carelon is continually pushing forward to engage patients at all parts of their wellness journey,” says Dr. Kwan. “We can meet patients where they are and will continue to do so.”
