Krakauer eol policy
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The Aetna Compassionate Care program provides specialized case management and enhanced hospice benefits to terminally ill members. The program aims to address barriers to optimal end-of-life care by helping members understand their options and access palliative care. A three-year study found significant increases in hospice use and decreases in acute care utilization among program participants. Feedback from members and families was also very positive about the emotional support and assistance provided.
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Krakauer eol policy
- 1. Ready Today for The Future of Health Care and Optimal Hospice Care Aetna Compassionate Care SM Program
- 2. ©2009 Aetna “ There is a great divide separating the kind of care Americans say they want at the end of life and what our culture currently provides . Surveys show that we want to die at home, free of pain, surrounded by the people we love. But the vast majority of us die in the hospital, alone, and experiencing unnecessary discomfort.” - Bill Moyers, PBS Commentator End of life care – current state
- 3. Historic Human Mortality Rates Hamourabi Codex Hipocrates Galen Koch Pasteur Sanitation Antibiotics
- 5. End of life care – current state ©2009 Aetna Lack of Knowledge about Care Options: Unfortunately, discussions with patients and families regarding terminal care and available options happen too late, or not at all. “ Acceptance of one’s mortality is a process, not an epiphany.” - Randall Krakauer, MD, Head of Medicare Medical Management, Aetna
- 14. Matched Study Cohorts ©2009 Aetna Aetna Compassionate Care SM
- 15. Results ©2009 Aetna Aetna Compassionate Care SM
- 16. ©2009 Aetna Results Commercial Case Management Group Commercial Members p<.0001 for each comparison Source: Evaluation of Aetna Compassionate Care Program, Aetna Inc., Aetna Health Analytics, September 2007, internal document.
- 17. Aetna Compassionate Care SM ©2009 Aetna Commercial Enhanced Benefits Pilot Group p<.0001 for each comparison Source: Evaluation of Aetna Compassionate Care Program, Aetna Inc., Aetna Health Analytics, September 2007, internal document . Results
- 18. Compassionate Care Feedback: cm note ©2009 Aetna Wife stated member passed away with Hospice. Much emotional support given to spouse. She talked about what a wonderful life they had together, their children, all of the people's lives that he touched - they were married 49 years last Thursday and each year he would give her a piece of jewelry. On Tuesday when she walked into his room he had a gift and card laying on his chest, a beautiful ring that he had their daughter purchase. She was happy he gave it to her on Tuesday - on Thursday he was not alert. She stated through his business he touched many peoples lives, and they all somehow knew he was sick, and he has received many flowers, meals, fruit, cakes, - she stated her lawn had become overgrown and the landscaper came and cleaned up the entire property, planted over 50 mums, placed cornstalks and pumpkins all around. She said she is so grateful for the outpouring of love. Also stated that Hospice was wonderful, as well as everyone at the doctors office, and everyone here at Aetna. She tells all of her friends that "when you are part of Aetna, you have a lifeline." Encouraged her to call CM with any issues or concerns. Closed to case mgmt.
- 19. ©2009 Aetna
Editor's Notes
- Terminally ill patients are forced to choose between life prolonging treatment and palliative support
- Members need to weigh the relative merits of one type of care versus another and choose what is best for them in consultation with their family, physicians and spiritual advisors. Our responsibility is to provide members with information and support so that they are able to make a well-informed decision. NHPCO – hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the person’s needs and wishes. Support is provided to the persons loved ones as well.
- This program is a unique offering in the industry. It follows Aetna’s goal of providing greater access to care and information, and places us as ‘Best in Class’ on this issue
- With the success of the ACCP program launched in 2004, Under the guidance Of Dr Rowe, there was a pilot conducted in 2005 with 13 large employers that expanded the definition of terminal illness from 6 months to 12months. allowed for curative care while in hospice and removed all day and dollar limits on inpatient and outpatient hospice benefits. This program is a unique offering in the industry. It follows Aetna’s goal of providing greater access to care and information, and places us as ‘Best in Class’ on this issue. This program is a unique offering in the industry. It follows Aetna’s goal of providing greater access to care and information and putting the member at the center of everything we do. Case Management Services - Helping members understand options, nurses were trained to : Assess and manage members’ care in a culturally sensitive manner Identify resources to make members as comfortable as possible, addressing pain and other symptoms Help coordinate medical care, benefits and community-based services Inform the member about treatment options, continuity of care, and advanced care planning Provide personal support 2) Enhanced Benefits Pilot Program* - Helping members access optimal care by eliminating barriers to hospice: Allow curative treatment Liberalize hospice entry requirement to 12 month terminal diagnosis (from 6) Remove day and dollar limits from hospice benefit 3) Website - Helping members understand care options, the Aetna Compassionate Care program website provides: Information on the dying process, the grieving process, hospice and palliative care support Information about decisions to be made, a checklist of important documents to compile, plus printable Advanced Directives and Living Will forms for several states Tips for beginning a discussion with loved ones about end-of-life wishes www.aetnacompassionatecareprogram.com
- Case management Aetna’s nurse case managers have long provided end-of-life care coordination as part of their responsibilities. However, our vision for the Aetna Compassionate Care program took these capabilities to the next level. All of our nurse case managers received additional training on issues specific to the challenges raised by these clinical situations, transforming support in this context into a core competency that is now an Aetna standard. To develop and deliver this training, Aetna has worked with the National Hospice and Palliative Care Organization, America’s oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals across the country
- In order to effectively do this you must always be aware of the members/families level of understanding-each situation is unique and you must make it a priority to know the literacy or emotional state of your audience (member, family, and caregiver) in order to have a discussion with them that is meaningful and understood. During a highly emotional time comprehension can be difficult especially when dealing with a life limiting illness... If the member agrees it is very helpful to have another family member present to hear the message you need to deliver.
- For the participants who had just the specialized case management program: The percentage using hospice and respite increased from 30.8% to 71.7% the average length of time in hospice increased from 15.9 days to 28.6 days The percentage with acute hospital admissions decreased from 42.9% to 22.7%
- For the pilot participants who had both the specialized case management program and the enhanced benefits : The percentage using hospice and respite increased from 37.9% to 69.8% the average length of time in hospice increased from 21.4 days to 36.7 days so the pilot program helped members use hospice services more and access hospice benefits at an earlier point in time relative to death The percentage with acute hospital admissions decreased from 40.3% to 16.8% [If question comes up on what was the cost associated with the providing more robust hospice benefits in the pilot, or whether any savings was achieved by a shift of costs from acute care to hospice, here is our answer…] The cost of the pilot program was low. We liberalized the benefits to remove barriers to optimal care at the end of life, we presented the care choices to the member through our case management, and as a result, members in the pilot chose hospice over other more expensive acute type care. Researchers found that hospice reduced Medicare costs by an average of $2,309 per hospice patient . The new study from Duke University appears in the October 2007 issue of the professional journal “Social Science & Medicine.” Additionally, Medicare costs would be reduced for seven out of 10 hospice recipients if hospice has been used for a longer period of time the study found. “ Given that hospice has been widely demonstrated to improve quality of life of patients and families...the Medicare program appears to have a rare situation whereby something that improves quality of life also appears to reduce costs,” - Don H. Taylor, Jr., assistant professor of public policy at Duke’s Sanford Institute of Public Policy
- First comment cont’d… She also wanted to thank Aetna for not thinking of them as a statistic and that it was nice to know that the insurance company was there for them. She did not expect such compassion from such a big insurance company. She does not hear that from other people. She was curious about our little unit and what we did.
- If customers are insterested in offering the expanded benefits now: At this time, we can work with self insured customers to follow the expanded hospice benefit model until we roll it out on a broader basis. For fully insured customers, we are currently reviewing state filing requirements to determine if any additional filings are necessary.