A deep dive into Advanced Care Planning (ACP), hospice, and advanced senior care at home

Bambi Francisco Roizen interviews Kumar Dharmarajan, Chief Scientific Officer of Clover Health, a Medicare Advantage company. Dharmarajan is a trained geriatrician and cardiologist. He delves into how Medicare Advantage works and how Clover Health is expanding to include other services for the elderly, such as hospice care, which is valued at $ 28 billion in the US in 2018. Clover Health began trading in January 2021 through a SPAC (Special Purpose Acquisition Company). The company has 58,000 members.

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Here are some takeaways:

– Medicare Advantage plans are an alternative to Medicare. They are similar to Medicare, but they are operated by private insurers such as Clover Health. A third of seniors choose MA, and more seniors are enrolling each year, largely due to the added benefits like eyesight, dentistry, and incentives to stay healthy.

– While MA networks have traditionally been limited to specific doctors, Clover seeks to broaden the options.

– Seniors can register for MA at their location around their October when open enrollment begins.

– COVID accelerated services for Clover members, e.g. B. Virtual video visits with Clover Assistant, the Clover platform that enables clinicians to virtually manage care. Clover helped its members get vaccinated, advertised drugs for mail order, and sometimes offered 90-day prescription lengths. Clover helped his network of doctors by paying not only for telemedicine but also phone calls.

– Advanced Care Planning (ACP) gives people the ability to plan their health needs before they get sick. Some documents they would carry out include: A living will is a legal document that states preferences, e.g. B. when a person’s heart stops, they would want breathing tubes; Representation in healthcare (essentially a power of attorney); POLST is a portable medical prescription that describes a person’s treatment preferences.

– Only a third of adults in the US have done an ACP (that is, any of the above documents, such as a will). Even people with HIV / AIDS, less than 1 in 5 people have advanced care planning. Check out this study: Approximately one in three adults in the US completes any kind of pre-determined end-of-life care policy

– Video-enabled communication makes advanced care planning more convenient for seniors. Clover Health is conducting a 5-year study to show that video-enabled communication can help expand ACP. Because there are few physicians who have specialized knowledge of advanced care planning, videos scale that knowledge to a wider population. The video enables vendors, social workers and community health workers to talk about end-of-life processes. Check out this study: Early Palliative Care for Patients with Metastatic Non-Small Cell Lung Cancer

– Palliative care and hospice (until 31:00). Palliative care is for patients with serious illnesses. Palliative care evaluates someone holistically – behaviorally, emotionally – in order to alleviate their illness and improve their quality of life. The hospice is a benefit for people who are expected to live six months or less. It does not try to extend life, but rather to improve the quality of life. It includes palliative care, but since it’s a medical benefit, it can also include home nurses or access to a chaplain. It is a range of services offered with limited life expectancy. Studies have shown that patients with advanced lung cancer assigned to palliative care / hospice live longer.

– Palliative care has shown that it reduces costs (until 3:00 p.m.). Studies have shown that patients who perform adequate ACP are likely to have lower costs over the past six months. The hospice generally lowers costs and can sometimes cut costs by up to 40% as people tend to leave the intensive care unit.

– The goal of Clover’s study of ACP is to identify members. (until 3:00 p.m.) Clover has identified the 2,000 most sick patients out of 50,000 members in New Jersey. The 2,000 receive basic domestic care. Clover spends up to 90 minutes in her home per visit. In the study, some were given video-based decision-making aids to determine which would choose ACP. Clover will keep track of whether they can get information, such as: B. Can bring wills, health care workers, or patients to a hospice.

– For the Medicare population in Clover’s primary care program, Dharmarajan estimates that telemedicine visits will account for a quarter to a third of all doctor visits.

– How is Clover different from other MA providers? (Go to 45:30). Clover doesn’t see himself as an actuary. It sees itself as a clinical service organization. The software is designed to help doctors make better clinical decisions. It’s not so much about price risk as it is about helping doctors make real changes in their care plans. In addition, Clover does not have legacy systems.

– Clover plans to enter into direct contracts as well. Read how hospices move to direct contracting.

– Clover has an advantage over other insurance companies when we switch to vulnerable, value-based care models. Because risk models require physicians to make different decisions, Clover’s technology platform is already designed to help physicians make those decisions for outcomes, rather than just helping physicians track services. Clover doesn’t have the baggage to change its legacy systems.


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