Thinking strategically about end-of-life care

By Turner West

The perennial growth in Medicare Advantage enrollment and the emergence of value-based initiatives and new payment models in traditional Medicare creates stronger incentives for efficient use of healthcare services.

In the context of serious illness care there are myriad opportunities to both improve patient experience and reduce healthcare expenditures by diminishing non-beneficial utilization of healthcare services and mitigating the likelihood that a seriously ill person will use the emergency department or hospital to manage their medical conditions.

Three Components

Bluegrass Care Navigators is applying 40 years of experience as a national leader in the delivery of hospice care to serve new patient populations. Caring well for the seriously ill person and frail older adult require at least the following components:

  • An interdisciplinary team approach consisting of skilled clinicians responding to the medical, social, psychosocial, existential, behavioral and practical needs of the person and family.
  • Around the clock access to a specially trained member of the interdisciplinary team. This support takes the form of telephonic consultation and in-home visits when necessary to respond to crises.
  • Deftly guided and recurring conversations on what matters most to the patient and family to ensure that all medical care aligns with the person’s goals and values.

Traditionally, scaling access to interdisciplinary care in a community setting for seriously ill and frail older adults has been limited by a predominantly fee-for-service reimbursement structure.

In the past few years, thanks to the trends in healthcare delivery, opportunities abound to scale access to needed healthcare for this patient population. Consequently, Bluegrass Care Navigators has made the strategic decision to develop several non-hospice service lines, including, but not limited to the following:

  • Bluegrass Palliative Care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Bluegrass Care Navigators offers palliative care services across settings.
  • Bluegrass Home Primary Care is a service under the care of a specially trained physician for those who are home-limited with complex healthcare needs.
  • Bluegrass Transitional Care is a service that uses two evidence-based models to help individuals transition home safely after a hospitalization with a focus on reducing the likelihood of a readmission.

From a strategic perspective, Bluegrass Care Navigators sees the broader healthcare trend to move away from a fee-for-service environment as an opportunity to scale community-based, interdisciplinary healthcare that reaches a broader patient population beyond those facing end-of-life.

-Turner West is AVP of Health Policy and Director of PCLC at Bluegrass Care Navigators.


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