Outpatient Home Based Palliative Care A Pilot Program of Hospice of Canada Payor Presentation

Summary of Need Need for home based palliative care far outweighs current capacity in both California and Canada County California County – 29% need/ 6% capacity Canada County -- 29% need/ 0% current capacity 1 Currently one palliative care provider in the county Access to services limited by payor/provider http://www.chcf.org/publications/2015/02/palliative-care-data 1. .Mapping Palliative Care Need in California, Kathleen Kerr and Kate Myers, 2014 Mapping Palliative Care need in California, Kathleen Kerr and Kate Myers Payor Presentation

Why A Pilot Project? Prepare organization for a large scale implementation Allow us to test assumptions Gather data and provide evidence to secure additional funding Identify challenges and mitigate risk early Prepare team for a more demanding program/growth Develop systems to communicate with physicians and community referral sources Payor Presentation

Initial Plan Year 1 Allocate $$ to develop a pilot program. Scope and model to be determined (approx. $450,000) Training, education and implementation Gather and analyze data Develop Community and Payor support Year 2 Evaluate data and Plan Future Project Identify Trends Estimate Need Determine costs to grow/expand Plan larger scale deployment Payor Presentation

$450,000 – A good start 1.0 FTE MSW (approx. $100,000) Add 1.0 FTE nursing ($90,000) Add .8 FTE Nurse Practitioner ($120,000) Add .20 FTE Medical Director ($50,000) Add 1.0 FTE Palliative Care Coordinator ($50,000) Additional expenses include marketing materials, business development activities, education and training, professional membership and consultation services (as needed). Payor Presentation

Tentative Budget Palliative Care Pilot Budget FY15/16 Annual Run Program Manager 143,750 45,000 Add 1.0 tele nursing 137,500 68,750 Add 1.0 NP 156,250 91,146 Add .20 MD 62,500 46,875 Add 1.0 Palliative Care Coordinator 36,458 Marketing materials, business development activity 10,000 20,000 CAPC Membership 3,500 Conferences/Trainings Legal and Insurance 15,000 Total incremental projected spend in FY 15/16 596,000 336,729 Payor Presentation

Palliative Care for 75 patients Provide Care to 75 patients over the course of 1 year (prognosis 1 year or less) Includes patients at (one) Skilled Nursing Facility Patients will transfer to hospice when prepared and eligible Average Length of Stay (ALOS) in outpatient palliative care can range from 1 month- 1 year but transfer to hospice within months is typical Define metrics and establish a baseline to improve outcomes and reduce unnecessary utilization of emergency medical services and/or hospitalizations Payor Presentation

Collaboration with Attending Physician While on Palliative Care services, the patient's Attending Physician (AP) will continue as the primary physician directing the patient's care The Palliative Care Medical Director serves as a consultant supporting the Attending Physician's treatment plan Collaboration with the AP for suggested changes in medications or symptom management The Palliative Care Team supports and assists the AP by providing additional care, support and oversight to their palliative patients Payor Presentation

Payment Models Per Member Per Month (PMPM) Pay for performance/outcome incentives A fixed fee intended to cover all palliative care services provided to a member meeting eligibility criteria Palliative Care Services can lower the cost of care for the network Example: $1200/mo. A lower fixed fee per month Incentive payments based on achievement of predetermined metrics (decrease in acute days) Example: $700/mo. fixed fee and $250/mo. incentive payment per member for no hospitalization Payor Presentation

Update: Final Model Contract initiated with physician payor group $1000 per patient per month for 6 months of pilot $700 per patient per month after 6 months Incentives TBD Assigned an RN Case Manager Monthly Care Coordination Meetings Payor Presentation