Provider Alerts

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Date:	July 31, 2017
To:	Health Plan of San Joaquin (HPSJ) Hospitals with Inpatient Palliative Care Programs – Chief Medical Officer, Case Management Team, Admittance Department, Hospitalists and Inpatient Palliative Care Teams
From:	Medical Management Department – Case Management
Subject:	NEW – Six Month HPSJ Outpatient Palliative Care Pilot Project
Business:	Medi-Cal

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With the launch of our new pilot project, Health Plan of San Joaquin now has in place an outpatient palliative care initiative offering in-home consultation and 24/7 telephonic support through two of our palliative care agency partners: (1) Community Care Choices – Palliative Care Program of Community Hospice (Stanislaus County) and (2) Transitions Palliative Care, a service of Hospice of San Joaquin (San Joaquin County). A second key part of this HPSJ pilot project includes an ongoing collaboration with San Joaquin General Hospital’s Palliative Care Clinic Program.

California’s Department of Health Care Services (DHCS) has let all California health plans know in a draft APL (All Plan Letter) that it expects to issue requirements for new community palliative care services.

ð The estimated effective date is projected for January 1, 2018 (date not yet finalized).

ð DHCS is acting in accordance with California Senate Bill (SB) 1004 (Hernandez, Chapter 574, Statutes of 2014).

Health Plan of San Joaquin has elected to offer outpatient palliative care services for HPSJ members beginning now, as a pilot project through January 2018. This pilot is intended as the basis for the new member benefit to be covered through the Medi-Cal program.

• This early implementation is made possible by a $25,000 planning grant from California Health Care Foundation (CHCF) which helped the health plan work with our community partners to develop this pilot project.
• HPSJ and the community partners have also received an implementation grant (up to $80,000 over a two year period) from CHCF. This grant will provide funds for education and training for the staff from each of our three community partners, outreach and education costs; oversight of program development and implementation and for data analytics and evaluation of the program.
• HPSJ will fund the cost of the pilot project for the clinical services. The pilot will focus on referrals from an inpatient setting.

HPSJ patients can be referred to one of our two community partner agencies when the hospital provider determines that palliative services are appropriate for members with one of these four diagnoses:

1. End-stage liver disease
2. Advanced cancer
3. End-stage COPD
4. End-stage heart failure

NEW – Six Month HPSJ Outpatient Palliative Care Pilot Project

July 31, 2017

Palliative care services being offered by our agency partners include:

• Advanced Care Planning and whole person assessment
•  Plan of Care
•  Care Coordination
•  Pain and Symptom Management
•  Mental Health (Social Services)
•  Palliative Care Team to address:
  • Physical
  • Medical Psychosocial
  • Emotional
  • Spiritual
• Goals include –
  • Improve quality of life for members
  • Develop community partnerships
  • Ensure advanced care planning
  • Communicate with the patient’s PCP, or specialist throughout the project

Workflow for this HPSJ Outpatient Palliative Care Pilot Project

• When an HPSJ member has one of the four (4) diagnoses and has had an inpatient palliative care consult, the attending physician at hospital will write an order for a Palliative Care consult.
• The hospital provider will contact the appropriate pilot project partner for the referral for a palliative care consult and admit as appropriate see community partner agency partners below for referral contact information.
•  The pilot partner agency will initiate the referral and have a Health Navigator go to the hospital to:
  • Provide information on the palliative care pilot services for the patient
  • Accept the HPSJ patient into the palliative care pilot (4) After hospital discharge, our partner agency will reach out to the patient to schedule services and in-home assessments. Services can be received as the patient wishes, either in the home or by telephone.

For Referrals – Community partner agency contacts for the HPSJ Palliative Care Pilot are:

• Community Care Choices – Palliative Care Program of Community Hospice, (Stanislaus Co.) Karen P. Hall, MSN, MSHA, RN-BC, CHPN, Director of Palliative Care Services, (209) 578-6354, Karen.hall@hospiceheart.org – After normal Business Hours: (209) 578-6333
• Transitions Palliative Care, a service of Hospice of San Joaquin (San Joaquin Co.) Sandra Smith, RN, Director of Palliative Care, (209) 922-0263, ssmith@hospicesj.org

For further questions about this pilot and/or Alert – Please contact HPSJ Case Management staff, Monday – Friday, 8a.m. to 5p.m., at (209) 942-6320.

Palliative Care refers to patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional and social, as well as spiritual, needs. Such care can be provided concurrently with curative care.

Hospice Care supports a delivery system geared to patients with limited life expectancy who are in the terminal state of an illness. While assisting patients, and family members, with a limited life expectancy, this care helps patients and family members cope as death nears.