Updated: CLAIM - Comprehensive Longitudinal Advanced Illness Management

 Care Coordination 
 CMS Demonstration 

Penn Home Care & Hospice Services, University of Pennsylvania Health System, Bala Cynwyd, Pennsylvania.
Agency Description:
Penn Home Care & Hospice Services consists of Penn Care at Home and Caring Way, both Medicare-certified and Joint Commission-accredited home health care agencies offering the full range of home care services, including skilled nursing, physical therapy, occupational therapy, speech therapy, social work services, and home health aides. Included in this entity is Wissahickon Hospice, a Medicare-certified and Joint Commission-accredited hospice agency. Wissahickon Hospice also operates Penn Hospice at Rittenhouse, a 20-bed hospice inpatient unit used for short-term symptom management and respite care.

CLAIM is housed within the Caring Way palliative home care program of Penn Home Care & Hospice Services. Caring Way services are designed for patients receiving treatment for a life-limiting condition. The Caring Way program supports patients' medical care by addressing their physical, psychological, emotional, and social needs. The goal is to provide the best in specialized palliative care so patients can remain at home, preserve their independence, and adapt to lifestyle changes during this challenging time. CLAIM specifically supports Penn patients with a cancer diagnosis by enhancing and increasing services provided by Caring Way.
Population Impacted:
The CLAIM program serves University of Pennsylvania Health System patients with a primary diagnosis of cancer who qualify for skilled home care in the Philadelphia area (including Montgomery, Delaware, Chester, and Bucks counties).
Strategic Partners:
The CLAIM program works strictly with Penn referral sources, physicians, social workers, etc. within the Penn health system. No outside partners are included. However, Penn Care at Home worked closely with CMS (Centers for Medicare and Medicaid) grantee contacts in terms of project updates, continued funding, and reporting.
Funding for this program was provided by Centers for Medicare and Medicaid Services Innovation Grant (CMMI).
Project Description:
The overarching goal of CLAIM (Comprehensive Longitudinal Advanced Illness Management) is to provide a comprehensive set of home care services, layered onto the existing Medicare Skilled Home Care Benefit, for patients with advanced cancer who have substantial palliative care needs but are not yet ready to enroll in hospice. The three primary aims of CLAIM are to:
  1. Help patients avoid unnecessary and undesirable hospitalizations. 
  2. Better manage pain.
  3. Provide more advance care planning support primarily by increasing the number and quality of goals of care discussions that staff have with patients and their families.
Mid-Program Results:
The CLAIM program results are from the end of June 2014.

Aim 1: A 10 percent increase in the proportion of patients whose pain is managed to a comfortable level: 
The historical control population’s controlled pain plus a 10 percent increase is calculated at 65.6 percent. For five consecutive reporting quarters, Penn Home Care is above this goal, showing that CLAIM patients have better pain management than the historical control group.

Aim 2: A 15 percent increase in the documentation of patient goals:
Data shows more than a 60 percent increase in the documentation of patient goals. Ninety-five percent of CLAIM patients showed evidence of goals documentation while on service in our last quarter compared to 58 percent of patients in the control group. 

Aim 3: Net cost reduction of $2,787,030 over three years:
Measurement for this aim focuses on inpatient hospitalization costs derived from University Hospitals Consortium data. The University of Pennsylvania Health System (UPHS) hospitalization costs are calculated per patient day, and are compared with the per patient-day costs of the control group to derive cost-savings estimates. The hospitalization rate (total UPHS hospitalizations/total number of patient days) for this quarter is calculated using our new historical control data set. A larger control data set was necessary to allow for future propensity score matching with our CLAIM population.   

Based on the cumulative health system hospitalizations through the end of the last reporting quarter, Penn Care at Home currently estimates a cost savings per patient per day of about $101. This estimate is based on the cost information for hospitalizations that occur within the University of Pennsylvania Health System for both the CLAIM and control group.
Final Outcomes:
Penn Home Care & Hospice Services coordinated with Penn Medicine to develop and implement the CLAIM program. The CLAIM program provided in-home support to certain qualifying patients with advanced cancer. The goals of the program include improving the quality of life, avoiding unnecessary hospitalizations and managing symptoms. Over the control group, the CLAIM program saw a rise of 30 percent in patients who feel that their pain is controlled (82 percent), an increase of 60 percent of patients who have documented their care goals (95 percent), and a reduction in costs of approximately $101 per patient. The accumulated savings over the three-year term of the demonstration was almost $2.8 million and ended at the end of the CMMI demonstration.