VNS Health EasyCare Plus: Help with Certain Chronic Conditions (Palliative Care)

Palliative care works to improve the quality of life for members and their families.  Members with serious illness may be eligible to receive palliative care.  Care is provided by a team of providers, nurses, social workers, nutritionists, and other specially-trained professionals.  The care team is curated for the individual and will work with them, their family, and their providers to help them live the best life possible.

Palliative care seeks to manage symptoms associated with chronic illnesses that can be debilitating and prevent people from doing what they enjoy, whether individually or socially.  Symptoms such as pain, nausea, weakness or fatigue, shortness of breath, or other variations of reduced mobility or decreased function.  It does not seek to combat or overcome existing illness when that illness reaches an advanced progressive stage.  Palliative care is a management, not curative, approach to treatment.

Those diagnosed with advanced heart failure (stage D/class III–IV), advanced COPD (severe), significantly reduced ejection fraction (39% or less)*, end-stage renal disease, dementia, cancer, or other serious illness, may be eligible for the Palliative Care program.  Upon eligibility and enrollment, a member of the health plan care team will make contact.  Together, a cadence of support calls is planned to ensure services are meeting specific health needs and to discuss other resources required.  Those in the Palliative Care program receive the following support through Care Management Services:

• Comprehensive care assessment at home with a nurse practitioner who will coordinate care with the primary care provider and care manager

• Advanced care planning

• Care planning and goals of care discussions

• Access to social services and community resources

• Continuous coordination with the primary care provider

Palliative care is not hospice care, though during the course of palliative care, one may become eligible for hospice.  Hospice is end-of-life care, available when a provider determines that the remaining life expectancy is likely 6 months or less.  Hospice care is also not automatic.  A person who qualifies for hospice care must elect to enter hospice with a written and confirmed statement.  (See the Hospice Care benefit for more information.)

Transitional concurrent care (TCC) includes services that may be needed for continuing care needs, as medically appropriate, for the treatment of a terminal condition. These services help provide a transition to hospice care and may include a phasing out of specific curative treatment over time. TCC requires prior authorization and is available for up to one month after electing hospice, though only if electing a network provider. If eligible, curative treatments may continue, such as palliative chemotherapy or hemodialysis, for up to one month after choosing a network provider.

*Ejection fraction is the amount of blood pumped out of the heart.  Reduced ejection fraction fraction means the blood being pumped out of the heart is less than the body needs.  An adequate or normal ejection fraction is 50%–75%.