Filling the Void in End-of-Life Managed Care

According to Dr. Alice Petrulis, chief medical officer for KePRO, the company's newest program completes the circle of total population management by providing quality health care and cost control for people who have terminal illnesses.

"As we work with employers and insurers through our other programs, we are able to identify members whose illnesses have progressed to the end-of-life phase. At this point, enrollees can't control the outcome but they can control the way they want to receive care. We offer them options," Petrulis says.

Once the company identifies members who can benefit from the program, KePRO case managers visit the enrollees to talk with them about their needs, expectations and desires as they progress through the terminal disease process.

"All too often, patients haven't talked about their wishes. Do they want to die in a hospital or at home? Do they want life-saving efforts or reassurance they will be comfortable and supported? Some may not have told their families what they want," Petrulis says.

"Our case managers are very sensitive, both to the difficulty of the discussion and to the cultural and religious beliefs related to end-of-life issues. Care plans are responsive to the specific needs of each person."

After talking with the enrollee, case managers then visit the patient's physician and provide a tool kit that contains the necessary legal forms along with the person's instructions regarding end-of-life care.

"The tool kit opens the door for dialogue between the patient and the doctor, making it easier for both of them to talk about what to expect," Petrulis says. "We also talk with the doctor about ordering hospice care. Many time hospices could do so much more for the patient and the family if they were involved earlier."

Petrulis says KePRO case managers closely watch specific symptom guidelines to ensure appropriate and quality palliative care is provided to reduce unnecessary emergency room visits or hospital stays.

"Shortness of breath, pain management and treatment for depression are all symptoms that can be controlled to keep the person comfortable. After the initial assessment, the case manager makes sure the physician knows about any signs of these key symptoms," she says.

As new issues arise, the case manager acts as an advocate and intermediary for continued symptom control.

As part of the end-of-life program, Petrulis says, "We make sure the patient has a medical home so that end-of-life care is coordinated through one doctor. If patients don't want to endure more chemotherapy or uncomfortable procedures, then there is less need to involve more specialty care."

For some patients, at-home telemonitoring systems are provided before hospice involvement, Petrulis says. This helps patients and caregivers better manage symptoms and avoid costly hospitalizations.

Petrulis says the at-home technology is well received by members. Insurers like it because of reduced costs, and physicians like how it helps them keep a close eye on their patients.

Like all of KePRO's comprehensive services, the end-of-life care program includes added benefits. Quarterly newsletters provide information about best practices and discussions about end-of-life issues.

"We've been providing quality disease-management services to employers, members and insurers for more than 20 years," Petrulis says. "Our new end-of-life care program fills an important and often overlooked void in total population management."

KePRO's end-of-life care program is available now. To learn how to implement the program in your organization, contact our business development professionals at 1.800.222.077.