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Evidence-Based Oncology April 2015
Palliative Care Integrates Value in Cancer Care
Joseph Alvarnas, MD
NCCN 2015: Reviewing the Past to Build the Future
Joseph Alvarnas, MD
A Need for More, Better, and Earlier Conversations With Cancer Patients About Goals of Care
Rachelle Bernacki, MD, MS; and Ziad Obermeyer, MD, MPhil
Creating Value-Based Metrics for Cancer Care: A Stakeholder-Informed, Evidence-Driven Approach
Scott D. Ramsey, MD, PhD; and Gary H. Lyman, MD, MPH
Q&A on Palliative Care
Andrew Smith
The Challenges With Ensuring the Validity and Utility of Diagnostic Tests
Surabhi Dangi-Garimella, PhD
Study Suggests Lung Cancer Screening Criteria May Not Capture All Smokers Who Need It
Mary K. Caffrey
From Choosing Wisely, Advice for Palliative Care Specialists and Guidance for Cancer Patients
Mary K. Caffrey
When Is the Right Time for Palliative Care in Oncology? The Sooner, the Better!
Marian Grant, DNP, CRNP, ACHPN, FPCN
How and Why Oncologists Should Do Palliative Care-or Get Some Assistance Doing It
Alessandra Colaianni, BA, MPhil; Sarina Isenberg, BA, MA; and Thomas J. Smith, MD, FACP, FASCO, FAAHPM
Palliative and End-of-Life Care: Issues, Challenges, and Possible Solutions in the United States
Kashyap Patel, MD; and Mary Kruczynski
Global Outlook on Palliative Care in Cancer
Megan O’Brien, PhD
Comprehensive Support for Individuals Living With Prostate Cancer and Their Caregivers Complements Palliative Care Services
Dan Klein, and Jamie Bearse
Patient, Physician, and Payer Conversations in Palliative Care: Moving Beyond Fear
Patti Forest, MD, MBA, FAAFP
Trading Conflict for Synergy: The New Normal for Oncology and Palliative Care
Michael D. Fratkin, MD
Currently Reading
The Role of Palliative Care in Accountable Care Organizations
Amy S. Kelley, MD, MSHS; and Diane E. Meier, MD

The Role of Palliative Care in Accountable Care Organizations

Amy S. Kelley, MD, MSHS; and Diane E. Meier, MD

Successful ACO palliative care programs share several key characteristics. First, these programs attempt to identify and target the high-need and high-risk patient population, preferably before a crisis hospitalization. The specific methods and criteria for patient selection vary, but most include quantitative risk-prediction models, prior utilization of acute care services (eg, ED or hospital admission) and qualitative assessments from the medical record, interviews with patients or families, or referral by clinicians. Quantitative risk-prediction models, which typically include age, gender, medical diagnoses and procedures, prescription use, and/or prior utilization or health expenditure, may be easy to implement but may fail to identify key predictors of risk for future utilization, including patients with functional impairment, cognitive impairment, frailty, social determinants of poor health (such as lack of food and housing), and caregiver burden.28

Second, successful programs use trained staff and/or facilitators to elicit individualized patient goals that are then used to guide care plans. This goal-setting, comprehensive needs assessment (including medical, behavioral, and social issues), and care plan development process contributes toward building a personal relationship between the patient, the family, and the care team or care coordinator. The care plan integrates medical services, including expert pain and symptom management, with social and psychological/ behavioral health support to meet the individual patient and family needs. The goal is to help patients remain as independent as possible, staying home and avoiding the ED and the hospital.29

Another key characteristic of successful palliative care programs is attention to the patient’s family and social support. This involves an assessment of family capacity and willingness to provide care, evaluation of social and financial resources, as well as access to telephone support for patients and their caregivers, 24 hours a day, 7 days a week (

Finally, these programs offer flexible “dosing” of services, with the intensity of the intervention and services provided scaled to patients’ needs, which fluctuate over time and over the course of a complex, serious illness. This flexibility allows programs to maximize the efficiency of their own resource utilization.

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