Palliative care case management: increasing access to community-based palliative care for Medicaid recipients.
OBJECTIVE
The purpose of this pilot project was to integrate palliative care principles and practices into the day-to-day operations of a Medicaid managed care provider. This was accomplished through the following five activities: (1) employment of an experienced palliative care nurse and social worker to serve as expert role models and consultants to the case management staff; (2) development of a palliative care training curriculum for case managers; (3) provision and evaluation of the training; (4) identification of appropriate patients, provision of palliative care case management (PCCM), and tracking of outcomes; and (5) development of a resource/reference manual for case managers.


METHODS
The project involved a managed care organization providing Medicaid services to patients residing in both urban and rural settings.


CONCLUSIONS
Expert staff was hired and modeled effective PCCM. This, as well as the training program, had significant influence on both the palliative care knowledge and attitudes of existing case managers. Involved patients demonstrated improved symptom management and satisfaction with care. Patient scenarios demonstrated desirable outcomes in healthcare utilization, and timely, appropriate hospice referrals were realized.


CONCLUSIONS
Integrating PCCM into the practices of a provider of Medicaid managed care can result in positive patient outcomes, improved utilization of healthcare services, and related savings for the managed care provider. Such a program can increase access to community-based palliative care for Medicaid recipients with life-threatening illnesses. PCCM can address the multiple needs of younger patients with serious illness who are not yet ready to forego curative efforts.
Head
Barbara A
BA
Interdisciplinary Program for Palliative Care and Chronic Illness, University of Louisville, 511 South Floyd Street, Louisville, KY 40202, USA. barbara.head@louisville.edu
LaJoie
Scott
S
Augustine-Smith
Lara
L
Cantrell
Mary
M
Hofmann
Dan
D
Keeney
Cynthia
C
Pfeifer
Mark
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration*; D003152:Community Health Nursing / Q000379:methods* / Q000458:organization & administration; D003479:Curriculum; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009732:Nursing Care; D010166:Palliative Care / Q000379:methods* / Q000458:organization & administration; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D012947:Social Work; D014481:United States