Episode 4 - Palliative Care

This episode is all about Palliative Care and VBID for Humana. We also discuss PIC:TFK and AVMED.

This episode is brought to you by Medical Administration.

Transcript

Hey everyone and welcome to this episode of TrustBytes, a Knowledge Center podcast bringing you educational material in a fun and easy format. I’m your host, Andrea Zuehlsdorff, eLearning Developer and Coordinator here at the Knowledge Center. Today we are joined by Valerie Valiante, Director of Palliative Care to talk about Palliative Care & VBID for Humana. So, let’s get into it. 
Today’s episode is brought to you by Medical Administration. The Medial Administration department consists of clinicians and administrators who support the doctors and nurse practitioners while they are in the field doing their daily patient visits. On a day-to-day basis, Medical Administration is responsible for approval of  complex case management funds, the creation and management of palliative care contracts, allocation of palliative care resources, reviewing the need for face to face visits, collaborating with patients and clinicians regarding outpatient visits, providing support for patients and families regarding their palliative care benefits, reviewing clinician visits for hospice coding and billing, submitting billing for hospice contract beds and palliative visits and monitoring CTI completion. Medical Administration collaborates closely with many other departments including business development, compliance, and admissions. Their function is to facilitate and optimize our clinician’s ability to provide great care to our patients. Before we begin, we want to welcome Valerie. Thanks for joining us today. Hi. Thanks for having me. Yeah. So, today we are talking about Palliative Care & VBID for Humana. As the Director of Palliative Care, can we say you are the subject matter expert? I guess you can. Ok. So I know palliative care and hospice care are both forms of comfort care provided to patients to reduce stress and offer complex symptom relief related to a serious illness and we all know that hospice care is end of life care, but what specifically is Palliative Care? Palliative care, specifically, is a medical specialty focused on relieving the suffering that often accompanies a serious illness or condition and providing the best possible quality of life for a patient and their loved ones. Palliative Care does not replace primary medical treatment and can be delivered at the same time as treatments that are meant to cure. So what you are saying is that palliative care may be offered at any stage of disease. Correct. Even during hospice care? Yes. Oh, ok. If we think about the word palliative, or palliation, it means comfort. Our main line of business at Trustbridge is providing comfort care, in other words palliative care, to terminal patients via the hospice benefit. So all hospice is a type of palliative care, but only for patients who are at the end of their lift. And, if we think about, patients who are terminal are not the only ones who deserve comfort care. So, today, when we talk about palliative care, we're not referring to palliative care under the hospice benefit for terminal patients, we're referring to patients who are not yet terminal but their suffering from a chronic disease and they need support from palliative providers or a palliative program. Ok. So, what else should staff know about Palliative Care? Well, Palliative care can be provided in different ways and it can look different for each patient. There are three main types of palliative care: Advanced Care Planning (which consists of goals of care conversations), Symptom Management (which is normally a collaboration between our medical team and the patient’s primary care provider or specialist) and Case Management (which involves our team overseeing a complex patient with one or more chronic illnesses with a goal of providing education, comfort, resources, and reducing their need for emergency services and hospitalizations). Each year, our physicians and nurse practitioners provide thousands of palliative consultations in a hospital setting throughout Palm Beach and Broward counties. And this year, we are very excited to talk about how we have moved into the home palliative market. That’s exciting that are moving into the home palliative market. We know Trustbridge offers programs for hospice patients, are there specialized programs at Trustbridge for palliative care? Yes, two of our current programs are the AVMED program and the PICTFK program. Oh, so PICTFK is a program, I wasn’t sure. I’ve seen nurses with this designation on their badges but wasn’t sure what it was. Can you tell us a little more about the program? Yes! PIC:TFK is a Medicaid program through Sunshine Health. It stands for Partners in Care: Together for Kids. This allows hospices to provide hospice level services to children who are not terminal, but their suffering from a chronic illness. It means we can provide nursing, CNA, respite, volunteers, music therapy, and more based on what the family needs and what the plan of care that we determine for the patient at the time of enrollment describes. These patients are not hospice eligible, but could really use that support that our services provide. This is actually the only palliative program that includes the entire hospice interdisciplinary team. As you know, we have many members of our hospice team that are experienced and trained in pediatrics and are already providing care to hospice patients. Because of this, we have been very lucky to recruit employees in each Area to help us with this program. We give them special PIC:TFK training and give them a special PIC:TFK badge, which is what you're referencing. Christy Florido is our provider for pediatric hospice in Broward and we're fortunate enough to have her leading this pediatric palliative patient program. If anyone who is listening is interested in participating, please email me for more information. Also, a fun fact: Trustbridge is the only approved pediatric palliative (aka PIC:TFK) provider in Palm Beach & Broward counties. So this program is very special and close to all of our hearts. We are so proud that this was our first palliative program at home. That’s very exciting; that's a great program, I’m so glad we are a part of it. You also mentioned AVMED. What is that? Yes, AVMED is an insurance company, and we are working very closely with them to help support their sickest patients in Broward county who are not yet on hospice. Our Palliative APRN, Peggy Anderson and our Palliative Social Worker, Alexis Aristizabal, educate and explain our palliative program (again, not hospice, this is for non-terminal patients) we identify what the patient's needs are, we provide support and resources as needed, and we visit the patient monthly to help manage their care. Our goal for this program is to assist with advanced care planning, or provide early education on hospice before they're ready, help manage medications and symptoms and overall, to help reduce the need for hospitalizations or the use of emergency services. These types of programs are very valuable for insurance companies and we're very lucky to be partnering with insurance companies like AVMED to be able to provide a palliative program that is paid for. Our palliative team also includes a Care Coordinator, her name is Medjina Calix, and she assists us with initial patient outreach, customer service, and administrative support of our programs. We've really built a wonderful team. Yeah, that sounds like it. The patients receive a monthly visit from the APRN, or can receive a visit as needed. As you can see, the palliative care at home program for non-terminal patients is very different from the hospice benefit and all of the services that we provide to patients who are eligible and terminal and consent to hospice.  You are right, it's very different but very helpful so that's a good thing. Now, we talked on our last podcast about the Hospice Medicare Benefit and how Hospice is covered under that, and I know it can also be covered by private insurance and Medicaid, but since Palliative Care is also pre-hospice, are they paid the same way? Yes, and no. Medicare, Medicaid and many private insurance plans may or may not cover the medical services provided by palliative care physicians and nurse practitioners according to whatever provisions are part of the insurance holder's policy. But much like the hospice program, it takes a team of care coordinators, social workers, and clinicians to provide a robust palliative program. These types of home palliative programs are not usually paid for, they're not reimbursed, which is why we have been working directly with different insurance companies on palliative contracts. With the new contracts we have in place, our home palliative services are pre-authorized and covered by the insurances that we're working with. You will be hearing more and more about the new programs that we want to roll out as we continue to pursue more contracts with more insurance companies. Our vision is to grow and expand the palliative programs to serve as many patients in Palm Beach & Broward as possible before they're even eligible for hospice. That sounds like a good idea; get them the help they need when they need it and then move them forward if need be.
I’ve been hearing a lot about VBID for Humana. What is VBID? VBID for Humana, which stands for Value-Based Insurance Design is a type of Managed Care Program. This means the insurance provider is holding providers accountable for the quality of care being provided. Traditionally, a patient is seen and then that visit is billed, this is what we call “fee for service” billing. VBID instead pays a certain amount per patient, and it’s up to the us to ensure high quality care that manages care for the patient in a cost effective way. Humana’s VBID program covers palliative at home AND hospice, and we are contracted with them! This means Humana patients under our hospice services receive additional benefits just for choosing us, since we are considered an in-network hospice. What are some of the benefits patients are eligible for if they have VBID for Humana and elect Trustbridge? Patients who elect hospice with us (an in-network VBID hospice provider) are eligible for additional benefits from Humana. They can get 31 days of transitional concurrent (hospice & curative care) can be utilized as part of the hospice POC. 5 (8-hour) In Home Respite care visits may be provided per year. And, $500 in supplemental benefits per year can go toward the member’s home repairs, medications, room & board, etc.
 |  Wow, that’s a lot of great information. Thank you for sharing with us today. You’re welcome. Thank you for having me. If staff have questions, who can they reach out to for help? They can call… Also, I am going to be doing a presentation on Hospice & Palliative Care this month at the speaker’s bureau. That’s great. Where can staff go if they want to sign up to attend? They can go to the Trustbridge website – Get Involved; and then click ‘Learn More’ under the Presentations for Healthcare Professionals. That will show all of the upcoming presentations; view the event they want to attend and register. Thank you for that.