Providers

Palliative Care Services for Dual Plus Members

Vantage offers palliative care and other services for Dual Plus members with advancing illness who are approaching end-of-life. Advanced Care Management (ACM) is a nurse practitioner-led community and home-based Palliative Care program that centers on a member support structure that activates an interdisciplinary care team to provide home-based and telephonic support. The goal is to improve quality of life for members and their families through strategies to prevent rapid decline, including early identification of the need for palliative care and relief of suffering through the treatment of pain and other challenges, whether physical, psychosocial, or spiritual.

The member’s primary care provider (PCP) remains in charge of the member’s overall care, writes orders, and sees the member for office visits during the course of palliative care. For a member enrolled in Advanced Care Management services, a specially trained care team works in partnership with the PCP and the member’s other providers to communicate and align on treatment goals and provide support to the member and their family and/or caregiver. Providers who are actively treating Vantage Dual Plus members can contact Vantage’s Integrated Care department.

Contact Vantage’s Integrated Care department about participating in this program. Integrated Care can be emailed at DSNPACMTeam@vhpla.com or call toll-free 888-823-1910, option 1, then option 5.

Please have the following member information available when calling about Advanced Care Management:

  • Member’s name and date of birth
  • Member’s Vantage ID number, if available
  • Member’s address and phone number
  • PCP’s name
  • Primary caregiver information, if available
  • Diagnosis
  • Referring provider’s name and phone number

Palliative Care Frequently Asked Questions

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Palliative care is appropriate at any age and any stage in a serious illness, and is based on the needs of the member, not the prognosis. Unlike the Original Medicare hospice benefit, palliative care does not have a prognosis restriction and may be provided alongside curative treatment.

The following criteria are considered:

  • One or more serious illness diagnoses, middle-to-late stage
  • Multiple co-morbidities
  • Cognitive or functional decline
  • Need for pain and/or symptom management related to chronic/life limiting condition
  • Psycho-social and/or spiritual distress of both member and caregivers related to chronic/life limiting condition
  • Need for advance care planning (including advance directives) and clarification of health care goals for members and caregivers
  • Members with end stage illness who have declined the Hospice benefit
  • Recent ER or Hospitalization last 90 days
  • Multiple hospital admissions or ER visits over the past year

A specially trained team, led by a nurse practitioner and comprised of doctors, nurses and other healthcare professionals, work together with the member’s regular doctors to provide an extra layer of support, at no additional cost to the member.

The following criteria are considered:

  • Multidisciplinary team providing in-home support (nurse practitioner, registered nurse, social worker, spiritual counselor)
  • Management of relief of symptoms, pain, and stress
  • 24/7 access and interdisciplinary tea support
  • Collaboration with member’s treatment team (e.g., PCP, specialists)
  • Linkages to community-based organizations and resources
  • Additional layer of support alongside curative treatment