John A Stoukides MD ScD Regional Chief Medical Officer CharterCare Provider Group RI Chief, Division of Geriatrics and Palliative Medicine Roger Williams Medical Center

Potential Benefits from a Comprehensive Palliative Program Improved Patient/Family satisfaction Reduced utilization of ancillary testing Reduced ER visits Reduced Hospitalizations Reduced Readmissions

CharterCare/Prospect CarePlus Palliative Program Screening all patients via Palliative Care screening tool All patients meeting criteria presented to Palliative care team Identification of patients with following criteria for pc or hospice screening (CHF, COPD, Cancer, Dementia, Bedbound, End stage CVA, End stage Parkinson's and age greater than 90 and homebound) Screen institutionalized patients for possible PC eval PCP Palliative outreach program

Dedicated palliative care program “Hospice Lite model” utilizing interdisciplinary team of physicians, nurses, social workers, chaplain and pharmacist Main objective is symptom management and control to avoid unnecessary ER visits, admissions and readmissions Establish advanced directives early in care process Program fully integrated with High Intensity Case management, social services and home pharmacy and social services Goals are to maximize care in the home setting by managing symptoms out of control,establish goals of care and to transfer appropriately onto hospice to maximize hospice alos

Value-Based Medical Management Programs 5 Medical Management Functions Staff Location CarePlus Complex Case Management RI CarePlus Care Transitions RI CarePlus Palliative Care Program RI CarePlus Hospital Case Management RI CarePlus SNF Case Management RI CarePlus Institutional Program (Long-Term Care) RI CarePlus Homebound Program RI CarePlus Pharmacy Program (MTM) (Home) CARI Prospect Integrated Behavioral Health (PIBH) RI Utilization Management - Elective Inpatient Stays & Complex Imaging RI Network Management RI Decision Support RI HCC/RAF Ca } RI

Potential Barriers Patient equating palliative care with end of life and or hospice care Physician lack of education regarding the difference between palliative care and hospice care Payment system that does not reimburse for team based care PCP disengagement

Funding under full risk model CHF in a risk group of 7500 patients, 75 patients with class 4 CHF total inpatient costs $4,500, Patients with Class 3 CHF total inpatient costs $3,375,000 Reduction in admission (25% $1,968,750) Nurse Practitioner $135,000, RN $80,000, Pastoral Care $60,000, Social Worker $60,000, Administrative support $45,000 (258,500) (3.3%)