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

2. 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
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

3. 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

4. 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

5. $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

6. 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

7. 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

8. 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

9. 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

10. 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