Healing more than bodies: Monarch Healthcare palliative care
Greg Kimura, MD, Director of Palliative Care Medicine, Monarch Healthcare
Monarch HealthCare is an independent practice association and part of Optum. Monarch delivers managed care for over 200,000 patients in Southern California.
They provide a wide breadth of services, contracting with 2,250 physicians in addition to employing 140 practitioners comprising primary care providers, advanced care providers, specialists and hospitalists.
“Cure sometimes, relieve often, comfort always.” — E.L. Tredeau
There are patients who, through age and illness, have reached the limits of what medicine can cure.
However, these patients are still within reach of healing. The Monarch Healthcare palliative team stretches the traditional bounds of medicine to support and comfort our patients with individualized, holistic care.
Working to expand the benefits of palliative medicine and in a continual effort to grow clinician and patient understanding of palliative as complementary to curative means, our care team exemplifies medicine that focuses on whole patient well-being to improve the lives and health of our patients.
Within the general population, 5% of patients, the most sick and vulnerable, account for 50% of health care spending.
With the vision and support of Chief Medical Officer Nancy Boerner, Monarch Healthcare has developed teams that focus exclusively on this 5% patient population, supporting them with three branches of palliative services tailored to meet the goals of the quadruple aim:
- Improve patient’s experience.
- Improve quality of care.
- Make care affordable.
- Improve provider satisfaction.
Monarch Palliative Care designated three groups of patients to be referred into our palliative care team’s management.
Branch 1: The high risk touch team
The high risk touch team (HRT) confronts the misconception that palliative care is for the dying. These clinicians are tasked with giving supportive care to patients recovering from serious illness.
Happily, hospitalization requiring critical care for major traumatic injury or severe illness often ends with recovery. However, when patients are ready for discharge they still face a tenuous road back to health.
One comprehensive post-discharge visit with the HRT prepares patients to transition from acute care to the community.
By reconciling medications, planning follow-up, preparing medical equipment, and educating on red flag symptoms, patients are ready for success in managing their recovery at home.
Branch 2: The palliative care team
This second group, seeing 800 patients per year, is the palliative care team. These patients have a prognosis of 15 months or less.
Some patients continue with aggressive treatment and others do not. Either way, alleviating pain and suffering, both physical and emotional, are key goals of the palliative clinician.
From finding a palatable food that gives pleasure and may help a patient gain weight to encouraging reconciliation between a long estranged parent and child relationship, this team practices the art of healing in the humanistic, compassionate tradition.
Some patients die from their illness, some are referred to hospice, some maintain their condition, while others get better and become a part of the supportive care group.
Branch 3: The supportive care team
Supportive care patients are the third group under the Monarch care palliative umbrella. This group includes patients whose illnesses are chronic and require large amounts of health care resources.
These patients may be coping with multiple comorbid conditions. Often anxiety and psychosocial factors exacerbate their symptoms. A complex medical picture and the absence of good social support may continue to bring them to the emergency department with physical and psychic pain.
Supportive care teams are comprised of advanced practice clinicians (APCs), social workers and a medical doctor with access to a chaplain. Patients in the supportive care program may also be discussed with a psychiatrist as needed.
Collaboration, compassion, communication, symptom management and planning are the tools needed to help these complicated patients. For many patients, having a trusted professional to reach out to makes all the difference.
Palliative care teams’ impact
The Monarch Healthcare palliative medicine team uses several metrics to show the impact of our work. Our High Risk Touch Team, seeing over 2,000 patients per year, has reduced hospital readmissions by 6%.
The palliative care team has reduced acute admissions by 28% and decreased length of stay by 15%. Patient satisfaction is at 98% across all of our teams.
These measures are essential to demonstrate the value of the three branch palliative care program, and lay the foundation to sustain our work into the future.
Palliative clinicians are privileged to work in an area of medicine where though we rarely get the chance to cure, we do our best work through understanding what matters most to our patients and supporting them in achieving their goals.
By restoring relationships, easing pain, and lending a caring ear to listen, we fulfill our mission even when science and technology have reached their limits.
Using the most human aspects of medicine, Monarch Healthcare makes sure that our patients get the best possible care by comforting, always.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.