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Palliative Care Case Management: Increasing Access to Community-Based Palliative Care for Medicaid Recipients

Head, Barbara A. PhD, RN, CHPN, ACSW; LaJoie, Scott PhD, MSPH; Augustine-Smith, Lara MBA; Cantrell, Mary RN, MSN, CHPN; Hofmann, Dan BS; Keeney, Cynthia RN, MSN; Pfeifer, Mark MD

doi: 10.1097/NCM.0b013e3181d18a9e

Purpose: The purpose of this pilot project was to integrate palliative care principles and practices into the day-to-day operations of a Medicaid managed care provider. This was accomplished through the following five activities: (1) employment of an experienced palliative care nurse and social worker to serve as expert role models and consultants to the case management staff; (2) development of a palliative care training curriculum for case managers; (3) provision and evaluation of the training; (4) identification of appropriate patients, provision of palliative care case management (PCCM), and tracking of outcomes; and (5) development of a resource/reference manual for case managers.

Primary practice setting: The project involved a managed care organization providing Medicaid services to patients residing in both urban and rural settings.

Findings/conclusions: Expert staff was hired and modeled effective PCCM. This, as well as the training program, had significant influence on both the palliative care knowledge and attitudes of existing case managers. Involved patients demonstrated improved symptom management and satisfaction with care. Patient scenarios demonstrated desirable outcomes in healthcare utilization, and timely, appropriate hospice referrals were realized.

Implications for case management practice: Integrating PCCM into the practices of a provider of Medicaid managed care can result in positive patient outcomes, improved utilization of healthcare services, and related savings for the managed care provider. Such a program can increase access to community-based palliative care for Medicaid recipients with life-threatening illnesses. PCCM can address the multiple needs of younger patients with serious illness who are not yet ready to forego curative efforts.

Barbara A. Head, PhD, RN, CHPN, ACSW, is Director, Interdisciplinary Program for Palliative Care and Chronic Illness, and Assistant Professor, School of Medicine, University of Louisville, Louisville, KY. She has more than 25 years of experience in hospice and palliative care.

Scott LaJoie, PhD, MSPH, Assistant Professor, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. He is trained in decision science and biostatistics.

Lara Augustine-Smith, MBA, is Data Analysis and Reporting Manager for Passport Health Plan, Louisville, Kentucky. Her career has been focused on quality improvement and data analysis.

Mary Cantrell, RN, MSN, CHPN, is Geriatrics and Extended Care Case Manager, Louisville Veterans Administration Medical Center, Louisville, KY. Previously, she did palliative care case management at Passport Health Plan, administered a hospital-based palliative care consult team, and was a hospice nurse.

Dan Hofmann, BS, has a degree in Business Administration with a minor in Economics from the University of Montana, Missoula. He has a decade of experience as a statistical and data research analyst with marketing research, commercial real estate, and healthcare companies.

Cynthia Keeney, RN, MSN, is Research Nurse, Interdisciplinary Program for Palliative Care and Chronic Illness, School of Medicine, University of Louisville, Louisville, KY. She has worked on several studies related to cancer symptom management and end-of-life care and is currently a master's student in nursing.

Mark Pfeifer, MD, is V.V. Cooke Endowed Chair, Department of Internal Medicine, School of Medicine, and Chief Medical Officer, University of Louisville Hospital, University of Louisville, Louisville, KY.

Address correspondence to Barbara A. Head, PhD, RN, CHPN, ACSW, Interdisciplinary Program for Palliative Care and Chronic Illness, School of Medicine, University of Louisville, MDR Building, Suite 110, 511 South Floyd Street, Louisville, KY 40202 (

© 2010 Lippincott Williams & Wilkins, Inc.