Mark's journey: a study in medicaid palliative care case management

Palliative care and managed care share the goals of providing comprehensive patient care in a manner that reflects the goals of the patient while controlling the use of ineffective, costly treatments and arranging for care in the most appropriate treatment setting. The purpose of this case study is to illustrate the integrations of palliative care principles and practices within a managed care organization serving Medicaid patients. The Five Principles of Palliative Care developed by the Last Acts Task Force are used to structure the description of the interventions of the palliative care case management team.

The practice setting is Passport Health Plan, the managed care provider for the state Medicaid program in Louisville, Kentucky, which serves Jefferson and 15 surrounding Kentucky counties. Care for the patient was provided by a nurse and social worker team specializing in palliative care case management.

Palliative care principles and practices can be successfully integrated into managed care as a means for providing quality end-of-life care, a cost-effective, yet patient-centered, approach to care, and an alternative when hospice care is not indicated or available.

Case management practitioners and organizations and the persons they serve can benefit from incorporating palliative care principles and practices into mainstream case management practice.