The Opportunity

Serious illness care is one of the few areas in healthcare where the quality of care for patients can be significantly improved while simultaneously lowering costs. Today, roughly 25% of all traditional Medicare costs are spent in the last year of life. During the last year of life, many patients experience unnecessary or unwanted hospitalizations, skilled nursing facility stays and ER visits, as well as undertake treatments that may conflict with their goals of care and fail to prolong their lives. 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 has built a network of specialty palliative care physician practices that provides comprehensive medical care for patients facing a serious illness. Aspire’s team of specialized nurse practitioners, nurses, social workers and chaplains is led by a board-certified palliative care physician. Our clinicians are available 24/7 to support our patients. Aspire’s clinicians are experts in symptom management, patient-family communication, advance care planning, and medical crisis prevention and urgent response.

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

  • Outreach to primary care physicians, specialists and other community providers as well as highly predictive clinical and claims-based patient algorithms to identify patients who might benefit from Aspire’s services
  • A dedicated, individualized care team for every patient that includes a physician and nurse practitioner as well as – depending upon a specific patient’s needs and preferences – a social worker and chaplain
  • An initial comprehensive assessment by a nurse practitioner that examines all aspects of a patient’s status (e.g. physical, psychosocial, emotional, spiritual) and accurately captures all of a patient’s existing conditions
  • A personalized, 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 specialists, who are kept up-to-date on and involved in any future changes to the care plan
  • Frequent, tailored touches from Aspire’s care team based on the patient’s specific needs, including regular visits to the patient’s home
  • 24/7 support to patients, including nurse practitioner home visits any time 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, physicians and health plans

It is so helpful to be able to call when I need something or have a question. My fear factor drops way down. Your care has kept me out of the hospital.

Trudy M, Aspire Patient

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