VIable

NDHI
NAT IONAL DIALOGUE FOR
Healthcare Innovation
Program for Advanced Illness
(PAI)
Organization Overview
• SCAN is a senior-focused organization committed
to meeting the needs of older adults and caregivers
through its health plan and community service
programs.
• SCAN Health Plan is one of the largest not-for-profit
Medicare Advantage Prescription Drug plans in the
nation, serving members in California.
Background
The U.S. healthcare system has begun to value
advanced care planning, as evidenced by CMS’s recent
approval of physician payment for voluntary end-of-life
counseling. As advanced care planning becomes more
of a focus, it will be important to maintain the highest
possible quality of life for seriously ill patients while
ensuring that appropriate and desired care is delivered.
Many SCAN members and their families expressed
a desire to better understand the decisions regarding
end-of-life care. They wanted greater involvement in
the decision-making process and assurance that the
patient receive care in his or her preferred setting.
As a result, in 2014, SCAN launched the Program for
Advanced Illness (PAI) for its members experiencing a
diagnosis of chronic or end-stage conditions to focus on:
• Enhancing quality of life.
• Improving care coordination.
• Increasing member, family and caregiver satisfaction.
Program Details
PAI is a thoughtful and innovative avenue for development
of standards in advanced illness planning. PAI
services make it possible for patients and their families
PAI: A Personal Approach
to End-of-Life Care
Rose, an 81-year-old patient,
knew that she did not want
to take extraordinary measures
to prolong her life.
Soon after she entered into
the PAI program, she was
evaluated for a tracheostomy
that would require longterm
care in a nursing home.
Rose discussed alternative options with her nurse
case manager and instead chose a less invasive
approach, which allowed her to spend her last days
in the comfort of her own home.
to understand the full array of care options available to
them and to receive treatment that best fits their values,
goals and cultural preferences. Through this program:
• SCAN works with its provider partners to identify the
patients that could benefit from participation (e.g.,
those with requirements and diagnosis of chronic
or end stage conditions).
• A palliative-trained nurse case manager serves as
the member’s personal advocate. The nurse:
––
Helps plan members and their caregivers navigate
care options that reflect each patient’s
quality of life goals and wishes.
––
Encourages articulation and documentation of
end-of-life wishes.
––
Identifies healthcare proxies and makes referrals
to hospice.
An Initiative of the
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Program for Advanced Illness (PAI)