Ohio-based palliative care provider Pure Healthcare is collaborating with the nonprofit managed care organization CareSource to implement a new care management model designed to support chronically ill patients.
The program is focused on patients who have illnesses such as cancer or cardiovascular or respiratory disease, among others. The initial rollout covers a 12-county region in southwest Ohio, but the organizations plan to expand statewide and beyond, according to Anthony Evans, president of Pure Healthcare.
“The goal is to really build off of Pure Healthcare’s accredited care management program and enhance it with the symptom management expertise that we have in our existing palliative care model,” Evans told Hospice News. “We feel the innovation is really the marriage of that enhanced care management model. With the skills that we bring to the table from our long history of palliative care, that really makes the biggest difference.”
The company’s palliative care model includes interdisciplinary services that include proactive symptom management and patient education with an emphasis on self-management, among other considerations designed to improve quality of life.
This model has a track record of reducing hospitalizations, emergency department visits and other costly interventions, Evans indicated.
CareSource, also based in Ohio, operates Medicare Advantage plans and one of the largest Medicaid plans in the nation, according to the company. It serves more than 2.3 million members in five states.
Geographic proximity is also expected to work in the partnership’s favor. Pure Healthcare and CareSource are both headquartered in Dayton, Ohio.
“It makes it easier for us to work together on these kinds of projects,” Craig Shrolucke, vice president of mission engagement and brand care for Pure Healthcare, told Hospice News. “These kinds of innovations, and even some of the [patient] monitoring are happening through collaborations that are right here, technology partners that are right here.”
Within the partnership, CareSource will identify patients in need of enhanced care management. They will receive services from a dedicated care manager, coordinated interdisciplinary care, guided education, medication review, care management tools and personalized care plans, in addition to access to community resources.
With the skills that we bring to the table from our long history of palliative care, that really makes the biggest difference.
– Anthony Evans, president, Pure Healthcare
CareSource will reimburse Pure Healthcare through a capitation total-cost-of-care payment model that includes a shared-savings arrangement, according to Evans.
“Our mission at CareSource is to make a lasting difference in our members’ lives,” Dr. Beejadi Mukunda, CareSource Ohio market chief medical officer, said in a statement. “We are committed to working with partners like Pure Healthcare and other organizations across the country to support our members, focusing on person-centered care.”
The palliative care provider has had a longstanding relationship with CareSource as a payer that has grown over time. Pure Healthcare has approached the managed care company with a number of care models designed to better support their chronically ill members, leading to several shared initiatives that have continued to expand.
“We just kept building on that relationship until we successfully negotiated this value-based contract that launched this week. They’re a very forward-thinking payer,” Evans said. “When it comes to innovation, they’re willing to view palliative care outside that end-of-life care box, and see it more for what it is — a really powerful untapped resource to support individuals who are facing chronic illness in all phases of the disease.”
