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‘Visionary’ Pilot Targets Palliative Care

A Medi-Cal managed care pilot program announced last week in Humboldt County will try a team-based, telemedicine-enabled approach to palliative care for patients with serious illnesses.

The nine-month pilot is due to launch Sept. 1.

Partnership HealthPlan of California, a not-for-profit organization handling Medi-Cal managed care in 14 counties — including Humboldt County — is contracting with ResolutionCare on the pilot program. 

“When you take a person who’s seriously ill and import them into the system, they become patients, no one really looks directly at them,” said Michael Fratkin, an internist and founder of ResolutionCare. “When you see people in the home, they’re people.”

That’s where the telemedicine component of the palliative care pilot comes in. Fratkin said a videoconference allows a seriously ill patient in rural areas to skip the hours of time it takes to get dressed and travel to a clinic. Fratkin said the immediacy of videoconferencing focuses all attention on the patient and that patient’s needs and concerns.

“When you turn that upside-down, you get rid of the overhead and you walk through the front door, that person feels cared for as a person,” Fratkin said. “That’s the basis of home care. By engaging through videoconferencing [during a follow-up appointment], within 15 to 30 seconds, the tech disappears, and it becomes a home visit.”

But because it’s virtual, Fratkin said, it’s cost-effective.

At first, Fratkin thought the telemedicine component might be too futuristic.

“Using home-based telemedicine services, that’s pretty visionary,” Fratkin said. “My original thoughts were this might be too forward, and not easily replicable or scalable. But that does not seem to be the case.”

Fratkin also telecommunicates regularly with the care team, which can include the physician, a nurse, a social worker and chaplain.

The idea is to use the limited resources at the disposal of rural providers in an integrated, efficacious way, he said. The pilot program also trains providers in the team approach.

Fratkin said the project stems from the edicts of SB 1004, by state Sen. Ed Hernandez (D-West Covina), which was passed during the previous legislative session, signed by the governor and went into effect at the start of 2015.

“We began this process as [a participant in] an advisory group to Partnership, to dig into a process and design a proposed model for how the benefit to Medi-Cal patients would be operationalized,” Fratkin said.

“We didn’t want to just extend hospice services they already provide,” he said, “but to provide services in a different way.”

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