Supporting members with complex, advanced-stage illnesses
Carelon serves as a trusted advisor for your most fragile members. Our personalized service addresses a member’s unique medical, emotional, and social needs.
- Care is tailored to relieve the psychological stress and symptoms of members’ advanced-stage illnesses. Our services are not end of life and don’t always lead to hospice.
- Physician-led interdisciplinary teams of clinicians, social workers, care coordinators, and specialists provides care and collaborate with members’ care providers and family to ensure best outcomes.
- The care team meets patients where they are — at home or virtually.
- Care providers receive clinical visit summaries to stay up to date on members’ Palliative Care assessments and to ensure continuity of care.
Percentage of healthcare spenders
Cost effectiveness of palliative care: Improved ROI
The top 5% of healthcare spenders accounts for 50% of total healthcare expenditures. People needing palliative care are among this groupi.
Learn more about Carelon's palliative care solutions
Download our case study to see how Carelon helped one health plan lower costs and support whole health for their members.
Who are our patients?
Palliative care serves patients with high-risk and high- cost chronic conditions, and those with serious illnesses. We are here to support them and their families at any stage of an illness. Our unique combination of services helps manage the challenges of living with:
- Advanced Cancer (Stage IV and certain Stage III cancers)
- Advanced Heart Failure (Class III-IV)
- Advanced COPD (Stage III-IV)
- Advanced ESRD
- End-Stage Liver Disease
- Advanced Neurologic Disease
- Advanced Dementia
- Others as deemed appropriate by Company’s clinical team
Intelligent patient discovery, personalized patient care
Our advanced data algorithm identifies the top 1% of vulnerable patients. Patients may also be selectively referred by case managers and physicians.
Patients are contacted by phone, mail, or email to schedule an appointment. We then meet them where they are to develop a personalized and comprehensive treatment plan.
Our physician-led interdisciplinary palliative care team
A physician-led interdisciplinary team provides care to help with the patient's clinical, social, and behavioral health needs. Teams include
- Board-certified palliative care physicians
- Registered nurse care managers
- Social workers
- National patient engagement team
- 24/7 clinician triage team
- Palliative care nurse practitioners
Physicians and nurse practitioners are on call 24/7
Unique interdisciplinary team experience
Physicians and nurses specialize in palliative care (physicians are board certified in palliative care or geriatrics), have professional memberships, and focus on quality measures.
Physicians publish clinical articles and speak at palliative care conferences. They also serve as media spokespeople for palliative care issues.
Clinical social workers provide direct mental healthcare services including therapy. In addition to a master’s degree, they must also pass a state licensure exam.
Our approach delivers industry-leading outcomes, value and improved ROI
Palliative care patients receiving ACP
Advance Care Planning
99% of Carelon Palliative Care patients completed an Advance Care Planning (ACP) discussionii with their care team in 2023. This compared to national benchmark of just 50%iii. The ACP discussion covers the patient’s goals and wishes for treatment, which leads to informed decision-making about treatment that may avoid aggressive treatment and hospitalizations.
Hospice median length of stay
Carelon Palliative Care’s hospital transition team helps ensure that patients that need to transition to hospice do so at the right time. The median length of a hospice stay for a Carelon Palliative Care Medicare Advantage patient was 42iv days compared to a national benchmark of 18 days.v
Hospice median length of stay
Cost effectiveness of palliative care: Improved ROI
Carelon demonstrates a return on investment of up to 3:1 for health plans who implement palliative care in Commercial and National Medicaid lines of business.
Carelon’s palliative care model: partnering to support members
Carelon’s approach to palliative care build partnerships with our clients to support their members and provide value to the health plan. That collaboration drives long-term, mutually satisfying relationships with our customers. We maintain a Net Promoter Score (NPS) of 77vi.
Data
Accurate member data is key for successful outreach
- "Client" to provide complete member information
- File includes phone numbers, addresses, and emails
- Review and correct data as needed
Collaboration
Carelon and client partner closely, ensuring effective outreach and enrollment
- Develop cobranded materials
- Leverage case managers for outreach when necessary
- Direct referrals from care providers
Engagement methods
Carelon leverages an omnichannel approach to drive engagement
- Members are engaged via texts, calls, letters and website presence
- Clear messaging educates members on the program and steps to enroll
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Learn more about how we can partner to provide cost-effective palliative care.
i 1 Center to Advance Palliative Care: Palliative Care: Facts and Stats (accessed October 2024): https://www.capc.org/documents/download/665.
ii Carelon JOC Dashboard – Medicare, Medicaid, Commercial data (measurement period is 2023, data as of April 5, 2024).
iii Agency for Healthcare Research and Quality: Decision Aids for Advance Care Planning (July 2014): ahrq.gov.
iv Carelon JOC Dashboard – Medicare (measurement period is 2023, data as of April 5, 2024).
v Carelon JOC Dashboard – Medicare (measurement period is 2023, data as of April 5, 2024).
vi (SMG) Service Management Group, 2025.
