The Opportunity Aspire Frist Quote

Advanced illness management is one of the few areas in healthcare where doctors and nurses can improve care for patients and their families while simultaneously lowering costs significantly. Today, over 25% of all Medicare costs are spent in the last year of life and, accordingly to the Dartmouth Atlas, costs for patients facing advanced illnesses differ significantly across geographies. Many patients often undergo unnecessary hospitalizations, skilled nursing facility visits, and ER visits in their last year of life as well as undertake treatments that not only fail to prolong their lives but are also often inconsistent with their goals of care. Patients facing a serious illness also experience severe symptoms like pain, nausea, constipation and shortness of breath that frequently go untreated, and both patients and their families often wrestle with complex emotions including fear, anxiety and grief.

Aspire Health’s Solution

Aspire Health is building a network of outpatient palliative care practices that will provide comprehensive medical care for patients facing a serious illness. Aspire’s team in each market is led by a full-time board certified palliative care physician who is supported by a team of specialized nurse practitioners, nurses, social workers and chaplains. Aspire’s practice in each market provides palliative care services across many settings including outpatient clinics, patients’ homes, skilled nursing facilities and assisted living centers. Aspire’s clinicians are available 24/7 to provide support to patients, including conducting home visits when necessary. Aspire’s clinicians are experts in symptom management, patient-family communications, advanced care planning, coordination with other medical professionals and support services, as well as medical crisis prevention and urgent response.

Although it can be modified to meet the needs of specific health plans, Aspire’s typical service includes:

  • A highly predictive, algorithm-based patient identification process
  • Each patient receiving his or her own care team that includes a physician, nurse practitioner and nurse as well as – depending upon a specific patient’s needs and preferences – a social worker and chaplain.
  • The team’s nurse practitioner conducting an initial comprehensive assessment that examines all aspects of a patient’s status (e.g., physical, psychosocial, emotional, spiritual)
  • This initial assessment documents all the patient’s conditions and can be used for HCC coding
  • Aspire’s care team then develops a comprehensive care plan for each patient based on that patient’s specific goals and needs
  • This care plan is developed in consultation with the patient’s PCP and specialist physicians, who are also kept up-to-date on and involved in any future changes to the care plan
  • The patient receives frequent, tailored touches from Aspire’s care team based on the patient’s specific needs, including at least monthly visits to the patient’s home
  • Aspire also provides 24/7 support to patients, including nurse practitioner home visits at any time of the day or night when necessary
  • The patient’s status, care plan and progress are tracked through a comprehensive information technology system that can produce a wide variety of reports for patients, caregivers, physiciansand health plans

Controlled studies have shown that outpatient palliative care programs have the ability to decrease overall medical costs by 30% to 40% primarily by decreasing unnecessary and preventable ER visits, hospital admissions, and skilled nursing facility and rehab admissions.

Benefits

Aspire Health’s solution is unique in that it offers benefits to patients and families, health plans, physicians and hospitals. The benefits to each of these stakeholders are:

Patients & Families

  • Highly personalized care focused on the needs of each patient and family
  • Honest discussion with a trusted clinician throughout the course of one’s illness
  • Improved clinical outcomes

Health Plans

  • Reduced medical expenses
  • Services count entirely against medical loss ratio (rather than administrative budget)
  • Allows health plan’s care coordinators to focus on a broader group of patients
  • Greater member satisfaction and engagement
  • Accurate HCC scoring
  • Improved clinical outcomes

PCPs & Specialist Practices 

  • Creates a mechanism for PCPs and specialists to provide care to their most seriously ill patients outside of the office
  • Saves physicians time and money by providing additional support to patients and their families
  • Improved information on patients’ health status when patients are out of the office
  • Improved clinical outcomes

Hospital Systems

  • Reduced medical costs for ACOs and bundled payments
  • Reduced readmissions
  • Improved clinical outcomes