Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : 7.4 Coordinate Patient Care across and within All Operating Units : 7.4.1 Case Study - EverCare Program, United HealthCare Corporation

EverCare is a demonstration program operated since 1986 by a national managed care organization, Minneapolis-based United HealthCare Corporation (UHC). UHC serves nearly 20 million people in all states and manages 19 health plans, with a total of 1.6 million enrollees. It has been a Medicare risk contractor for almost 15 years.

EverCare is a five-year demonstration project sponsored by the U.S. Health Care Financing Administration at nine sites nationwide. Its primary goals are to improve management of specialized acute care and to restructure service delivery and financing for the frail elderly in nursing homes. Like PACE, the program emphasizes preventive medicine and early intervention and limits unnecessary care. And, like PACE, EverCare receives comprehensive capitated payments, putting it at risk for virtually all Medicare-covered costs.

EverCare is available to Medicare-certified nursing home residents on Medicare (Parts A and B or Part B only) but not enrolled in hospice or an end-stage renal disease program. Once enrolled, members must continue to pay Part B premiums. Capitated, risk-based financing of all acute medical services provides flexible use of funds.

The EverCare team includes a physician and a nurse practitioner trained in geriatric medicine; while the nurse conducts the initial assessment, the nurse and doctor together develop the care plan. The nurse practitioner serves as the case manager and communicates with the patient's family. By using a provider team to monitor patients, the program promotes continuity. Because the team has several patients at one site, visits are more frequent, and the team develops a stronger relationship with patients and with nursing home staff. The nurse visits each patient at least monthly and is available during working hours; on-call backup is available after regular hours.

The nurse practitioner can also pre-authorize hospitalization and appointments at other medical facilities. If the nursing home staff are concerned about the need for acute care, the nurse practitioner examines measures to be taken and, if hospitalization is required, consults with hospital staff to discuss the patient's care.

To date, the program's results indicate a 30 percent decrease in costs compared to fee-for-service equivalents and a one-third reduction in hospital admissions. However, it has been difficult to expand the program because HMOs are reluctant to target the frail elderly, whose care they have little experience managing; physician networks are reluctant to take on the financial risks of a large geriatric population, because a special understanding of the nursing home environment is essential - and some groups are unable to develop this relationship.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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