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Palliative
Payors

WVHPCN is a provider-led collaborative that focuses on expanding palliative care utilization to improve care outcomes, enhance the patient experience, and reducing the overall cost of care for seriously ill patients of all ages. 

 

WVHPCN members regularly produce quality outcomes by adhering to network-level standards and participating in the network’s data collection and quality program. The network utilizes an attribution model to manage chronic conditions, reduce avoidable hospitalizations & utilization, and increase access to services while improving the overall patient experience.

 

With so much value for payors and patients, the network seeks to create, expand, and enhance relationships with Managed Care Organizations through innovative programming and alternative payment contractual arrangements. 

 

Value of Community-Based Palliative Care

 

Community-based palliative care can prevent unnecessary ER visits and hospitalizations by anticipating, preventing, and relieving suffering related to a serious illness or the side effects of treatment. More importantly, community based palliative care effectively identifies and addresses the non-medical, social determinants of health that have a significant impact on patient health and identification of high risk for poor outcomes.

 

Advance Care Planning provided by specially trained hospice and palliative care clinicians—who have experience in intentional and meaningful conversations regarding the understanding of disease progression, and exploration of the burdens and benefits of treatments and establishment of goals that are adjusted throughout the palliative trajectory—is the cornerstone of community-based palliative care.​

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A Home Palliative Care Savings study published in the Journal of Palliative Medicine revealed the following:

 

  • Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group

  • Members enrolled for 1–5 months, annual gross savings were $23,314 per member; 15.8% decrease

  • Members enrolled for 6–12 months, annual gross savings were $26,409 per member; 17.9% decrease

  • The savings were most prominent for the commercial insurance product with a 51% decrease in annual costs

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Gordon MJ, Le T, Lee EW, Gao A. Home Palliative Care Savings. J Palliat Med. 2022 Apr;25(4):591-595. doi: 10.1089/jpm.2021.0142. Epub 2021 Oct 8. PMID: 34637346; PMCID: PMC8982121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982121/#B4

Network Palliative Standards

 

WVHPCN maintains a high-level of care through adherence to certain standards.
 

  • Eligibility criteria that consider a patient’s illness, current health status, quality of life, and/or care needs

  • Timely referral and admission

  • Timely discharge or symptom management

  • Development of a comprehensive care plan that addresses key needs

  • Improved symptom management that reduces “downstream” spending”

Network Palliative Metrics

 

WVHPCN collects and evaluates certain data metrics to improve quality over time.
 

  • Recognition of patient appropriateness and transitions of care

  • Identification of partners and educational opportunities

  • Overall utilization of services  

  • Identifying and reducing unnecessary care    

  • Advance Care Planning for patient and family satisfaction

Business Partners

Partner with WVHPCN to better manage your seriously ill plan members

Palliative care can reduce unnecessary spending on patients who predictively will cost their health plan lots of money. This is accomplished through a partnership between a health plan and providers that improves care coordination and service delivery, which keeps those individuals out of higher-cost institutional care settings. By working together, sharing knowledge, and communicating effectively, health plans can offer their patients the highest level of care that addresses not just their medical needs but also their emotional and spiritual well-being.

 

That’s why WVHPCN is always looking to expand its partnerships with health plans who seek to provide seriously ill patients with a better health care experience. If you are a West Virginia health plan interested in learning more about the network and potentially contracting with network providers, we encourage you to contact us today!

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