Groups Share End-Of-Life Practices

Last month 11 of California’s most prominent medical groups gathered in Long Beach to share best practices as it relates to senior care. What made this gathering so special is that competing medical groups came together to openly let competitors “peek behind their curtain,” learn from their experiences and, in fact, encourage others to adopt their proprietary processes as it relates to multiple chronic disease management and end-of-life care.  

Motivated by the aging of society, new payment mechanisms, and greater consumer awareness, the healthcare industry needs to find new ways for creative collaboration and this summit – co-sponsored by SCAN Health Plan and the UCLA Multicampus Program in Geriatric Medicine and Gerontology – was an important step in advancing that effort. Central to this is the sharing of ideas, and at last month’s summit share they did:

• Monarch HealthCare shared its Outpatient Palliative Care Program where a multidisciplinary team makes home visits to patients who have declined hospice and are deemed to be in their last year of life. This program allows patients to continue curative therapy while providing an “extra layer of support” and the result has been a 57% decrease in hospital admissions while receiving high praise from patients and their families. 

• HealthCare Partners discussed its advance-care planning program for patients who may be in the last year of life. Upon enrollment in the program, a patient and his/her surrogate meets with a trained facilitator, typically a social worker, and through a series of facilitated interactions meaningful discussions occur between the patient and surrogate. The decisions are then legally documented and placed in the electronic medical record.

• Brown & Toland Physicians shared its population health management program aimed at reaching Medicare patients at high risk for hospitalization. Based on a combination of sophisticated medical analytic tools and provider input, this program connects patients with care managers who closely monitor the patient’s health and coordinates care across the full continuum. The first year of full implementation saw the inpatient utilization rate drop by 25% and a cost savings of almost $11 million. 

• MemorialCare Medical Group shared its best practice in assuring that appropriate hospitalized patients receive a palliative care consult. The group introduced a nurse training program in the “Ask, Tell, Ask” communication model that includes engaging the attending physician in submitting a palliative care referral request. Outcomes include a significant increase in the number of palliative care referrals as well as anecdotal evidence of improved nurse job satisfaction.

• Hill Physicians Medical Group discussed its Virtual Care Team Initiative to reach high-risk patients. This interdisciplinary team includes nurse case managers, social workers, pharmacists, and health coaches and serves as an extension of smaller practices in provided coordinated care. The program builds upon Hill Physicians’ patient-centered medical home pilot project which has had a positive effect on readmission rates, emergency room usage, chronic condition screening rates and patient satisfaction.  

At the summit, attendees worked directly with experts from the five presenting groups as well as with gerontology experts from UCLA and SCAN in learning how to implement one of these best practices within their own organizations. Clinical and operational counseling and mentoring will continue over the next six months as these groups work to implement new programs to better serve their patients. 

In order to enrich the patient experience, improve health outcomes, and reduce the cost of care, healthcare organizations must work together as never before. Driving the adoption of best practices is a critical step toward achieving these goals across entire populations. 

Raymond Chan, M.D., is the medical director of SCAN Health Plan in Long Beach.