The Serious Illness Care Program will launch on January 1, 2021. This new program supports Blue Advantage® patients with serious illnesses and the providers who care for them. It will improve the quality of life for both patients and their caregivers.
About 80 percent of crisis emergency department visits and hospitalizations (excluding pneumonia) are due to exacerbation of pre-existing and chronic conditions, such as shortness of breath in COPD or chest pain in cardiac illness. A recent study found that two-thirds of medical practices lack systems to assess patients’ wishes or adequately assess symptom burden.* These gaps in care leave patients and families with few viable options for relief of symptoms and stresses except to call 911 or visit an emergency department.
The Serious Illness Care Program promotes an extra layer of disease-directed therapy to help fill these gaps. It reduces healthcare utilization because it addresses the root causes of acute care utilization—poorly managed pain and symptoms as well as overwhelming caregiver stress and burden.
The Serious Illness Care Program is limited to Blue Advantage patients who have a proven advanced illness or multiple chronic conditions as well as a diagnosis of at least one of the following:
- Chronic Heart Failure (stage 3 & 4)
- End-Stage Renal Disease (dialysis patients only)
- COPD (stage 4)
- Metastatic Cancer
These patients can enroll in the Serious Illness Care Program to receive support from social workers and assistance from Case Managers who are specially trained and experienced registered nurses. These experts provide:
- Pain and symptom management
- Care coordination for medical and social needs
- Advanced care planning
- Referral to home-based care for members with higher need
Care through this program occurs on a continuum – from diagnosis to the end of life. It is not necessary for a patient to withdraw from therapy or to have a DNR status in order to participate.
In addition to patient and caregiver satisfaction, we will be monitoring hospital admissions/readmissions, emergency department visits and the number of days on hospice.
A patient who has received care from a physician participating in the Serious Illness Care Pilot Program will receive a survey regarding his or her care. The survey can be completed by the patient or caregiver.