MoreCare's Advanced Care Planning Program Supports Caregivers, Gets Results

"A lot of SNP members have had challenges related to health equity barriers for the majority of their lives. We saw a need to strengthen caregiver support as an extension of providing member support," says one MoreCare leader.

MoreCare—a Medicare Advantage (MA) plan for residents of Cook County, Illinois—has reported significant results from its expanded caregiver support partnership with Carallel. In a recent pilot, 62% of members and their caregivers signed up for MoreCare's Advanced Care Planning (ACP) program with 100% going on to complete the program. ACP, which facilitates end-of-life conversations, reflects a "human-led and tech-enabled" approach that starts with empathy and continues with a scalable care management platform that will help the plan expand ACP and other Carallel services to all members.

A growing partnership

MoreCare's enrollees include many Special Needs Plan (SNP) members, including those dually eligible for Medicaid (D-SNP), those with chronic conditions (C-SNP), and those living in long-term care (LTC) institutions (I-SNP). These specialized member needs are the foundation of MoreCare's partnership with Carallel, which began in 2021 and grew to include ACP. The engagement rate for the innovative ACP pilot was, according to Carallel, "nearly six times higher than the industry average for comprehensive care management programs."

These results apply to members of a single LTC facility, with MoreCare working with Carallel to prioritize more members. Abby Sibley, MoreCare's associate director of clinical initiatives and product, describes the pilot and plans for expansion. "Our first program was in a specific facility. Turnout was beyond even what we thought it would be."

Sibley adds: "Our goal is to go to every facility where we have members. It doesn't matter how many members are there because these are individualized conversations."

Challenging but important conversations

Those conversations with members, caregivers, and loved ones include the well-known Five Wishes document and help establishing powers of attorney and living wills.

Scott Sarran, MD, CMO at MoreCare, notes: "There are no more difficult or important conversations to have than those around the end of life." He adds that these conversations can be particularly difficult for members with long-standing, unmet needs tied to nonclinical factors such as social determinants of health. His colleague Sibley agrees.

"A lot of SNP members have had challenges related to health equity barriers for the majority of their lives. We saw a need to strengthen caregiver support as an extension of providing member support."

Through the MoreCare-Carallel partnership, this support is diverse, notes Carallel CEO Shara Cohen.

"It started with broad support, with our experts acting as extensions of the care management team. MoreCare then saw the opportunity to tackle specific challenges like ACP."

Cohen continues: "Unpaid family caregivers are part of the healthcare workforce and like the rest of that workforce, they are overwhelmed. They need support for a broad range of responsibilities. We also recognized that caregivers provide key opportunities for improving patient care. They are one of the most important influencers in a loved one's outcomes."

A human-led approach

Both MoreCare and Carallel attribute the program's initial success to their approach.

Says Carallel’s Cohen: "These are complex topics to confront. By investing time upfront to facilitate empathetic conversations with real people, we get tremendous results."

Sibley adds: "Our approach was to hold meetings prior to the ACP introduction to help members understand. But what had largest impact was Carallel going the extra mile—taking the time to come back and have one-on-ones after the information sessions and walk members and caregivers through the Five Wishes document."

Tech-enabled scalability

As with nearly all healthcare solutions, the MoreCare/Carallel offering includes a tech platform component. Carallel helps facilitate monthly case reviews and documentation needs.

"Advanced care planning documentation is fairly straightforward, but technology can add speed [to the process]," says Cohen. "It must be accessible to the PCP and the assisted living facility. The platform adds structure to unstructured information and, for broader needs, helps create segmented datasets to identify needs and match people to programs."

Preceding the documentation is how to identify and prioritize members and their caregivers for ACP and other programs. Cohen notes: "We are starting with the I-SNP population, then looking at secondary and tertiary identifiers." These include high-cost D-SNP and C-SNP cases, as well as member diagnoses, age, and other factors.

A human/tech solution for plans of all sizes

MoreCare and Carallel see even more opportunities for their partnership and for other payers.

Cohen says larger MA plans can benefit from its platform and programs just as much as local plans like MoreCare. "While the program for MoreCare was specialized, larger plans also have high-cost, complex members and a need to focus on them," says Cohen. "The ability to provide broader caregiver support at scale is important, especially as there are more MA age-ins."

MoreCare’s Sarran identifies multiple examples of the better outcomes caregiver support can help deliver for patients and health plans: "Avoiding hospitalization and overmedication, but also addressing earlier—through physical, social, and cognitive support—what is causing symptoms." A press release regarding the MoreCare-Carallel partnership notes that "[t]he support highly engaged caregivers provide is linked to significantly better outcomes for those in their care, including 30% lower rates of emergency department utilization and 50% lower hospital utilization."

Regarding payment and benefit design, Sarran adds: "This is an allowable supplemental benefit that is a way for plans to differentiate."

Carallel’s Cohen identifies additional benefits that are emerging through her company's partnership with MoreCare: "As we continue the program, we are looking at other key metrics where there is opportunity for improvement." 

Sarran sums up one of the biggest opportunities of all: "Our goal is to help people go through this last phase of life in as productive, sensitive, supportive, and high-quality a way as possible. It takes a village to make that happen."