Futile Care Identification Tool Improves the Value of Palliative Care

A rather somber discussion occurred at some point during my fourth year at Jefferson Medical College—4 decades ago this year.

A distinguished older physician described how people change over time due to a myriad of variables including bad habits, lifestyle, trauma, weight gain, age, illness, etc. He talked about how our abilities “dwindle” over time—an insidious slow drip phase of decreases in physical, mental, and structural human capabilities. A rather simple word picture I never forgot. 

None of this was earth shattering. If you are born, you will eventually die. The two are connected over time.

But, our medical system has not really dealt with the end of this continuum—“the dwindle phase.”

We offer prenatal care, followed by preventive care such as immunizations and lifestyle management. We do health screenings and when we find illness, start to treat with a wide variety of drugs, devices, and procedures. Then, seemingly in a sudden manner, people crash.

At this point, we rush people to the hospital—where most people die. In fact, Stanford University states that 20% of people die in their home, 20% die in a nursing home or hospice and 60% die in an acute care hospital—a rather over-medicalized death. But studies have shown that 80% of people would rather die at home. This medicalized death experience is not only highly expensive; it is typically not of high quality and is not at all satisfactory to the patient or family.

So, if 100% of people die, most of whom follow a predictable trajectory from health to “dwindles,” to death, then why is it that we cannot anticipate those who will eventually rush to the hospital to die in an unsatisfactory way?

Most people near the end of life demonstrate evidence of their slow deterioration many months or even years prior to their eventual death. The challenge is to identify them prior to their death and at a time where, what has been termed advanced illness management, might help them in their last years. 

Turn-KeyHealth, a company headquartered in Philadelphia, wants to change all of this in a rather simple and scalable manner. 

Turn-Key uses payer-partner claims data to identify those patients who are likely to receive futile care during their last year or so of life.  Their proprietary algorithm and analytics identify advanced illness patterns in patients, and who are predicted to experience an over-medicalized or inappropriate death. The data is stratified and then populates a mobile platform that instructs and guides its’ affiliated advanced illness management trained palliative care providers on comprehensive telephonic and in-home patient assessments, interventions, and real-time risk stratification.

The community-based advanced illness management providers typically reside within local hospice and palliative care organizations. These specialized clinicians provide field based engagement and support. Symptoms are reviewed, gaps in care identified, and medication reconciliation is performed. Goals of care and care plans are discussed in conjunction with the treating physician.

Their goal is to not only provide a highly desired service for these fragile people and their families, but to also decrease the futile hospitalizations; which some studies have suggested to be as much as a 43% reduction.

Turn-Key targets payers and at risk provider organizations focused on Medicare beneficiaries (Medicare Advantage, MSSP Accountable Care Organizations and MA-SNP’s). Their model successfully tackles the impact of the senior population that is growing by 10,000 people each and every day.

Turn-Key has demonstrated a 32% reduction in admissions to the hospital, a 61% reduction in readmissions to the hospital, a 37% reduction in ICU days, and a 19% reduction in cost—with almost perfect satisfaction measures.

And, interestingly other data suggest that when people are treated with an advanced illness management approach, they actually live longer.

After 4 decades of being enmeshed in our medical delivery system, it is refreshing that a company such as Turn-Key can finally address this universal part of life.