Health Plans

PCA FOR HEALTH PLANS

Palliative Care Alliance (PCA) is a healthcare solution that specializes in identifying whether health plan members are at risk for inpatient admissions and readmissions. We have found that our service significantly reduces the need for inpatient hospitalization as it relates to serious and chronic illnesses.

Using experienced, clinical personnel we have demonstrated significant member satisfaction by offering:

  • The optimal alternative to an emergency department visit
  • The promise of continuity of care at home to avoid hospitalization
  • Comprehensive patient education of their disease management
  • Guidance and instruction regarding prescribed medication
  • Improved pain and symptom control
  • Increased patient and family satisfaction with the healthcare system
  • Superior cost effectiveness for health plans and hospitals
  • Ease of access to advance directive discussions
  • Increased community resource provision and utilization

The primary objective is to keep your members free of pain and other symptoms related to a chronic or serious illness. Services include visits from a physician, nurse and medical social worker. Together the team develops a plan of care that is customized to address the needs of each member. Every member will be seen in the home setting with as many visits that are considered appropriate based on the customized plan of care. Additional resources and specialty services can be offered in order to keep a member in their residence to avoid unnecessary hospitalization.

Collectively the team improves member outcomes by proactively anticipating problems, seeking them out and addressing them. Once high risk members have been identified and referred to PCA, the team is ultimately responsible for:

  • Coordinating and managing care across all settings
  • Providing continuous assessment and reassessment of care
  • Seeking advice from primary care physicians and specialists
  • Promising consistent availability if emergent needs arise
  • Discussing prognosis and reasonable expectations
  • Providing outcome reports to the health plan on a regular basis

Ultimately, the overall goal is to provide support and education to the member and their family. This includes teaching them about the expected course of the disease, preventative care, medication use, and self-management and crisis intervention in the home.

  1. Continue reading: "Palliative Care Alliance: A Benefit for Health Plans and Their Members"