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Advanced Care Management

Advanced Care Management

Advanced Care Management is a care model designed to bridge gaps and improve care and clinical outcomes for patients with serious illness. We use advanced analytics to identify candidates, then work with Payors and Accountable Care Organizations to provide holistic, person-centered palliative care. 

For Patients

Our teams meet patients where they are, providing high quality care from telephonic check-ins to in-home provider care. Compassus’ person-centered approach to care increases peace of mind for patients and their loved ones.  

For Plans

With ACM, our partner organizations have experienced total cost of care reductions in the last year of life up to 35%, due to increased access to high quality hospice care and reductions in unnecessary emergency department visits and inpatient stays. 

What services are provided? 

  • A nurse practitioner and health care team to visit patients in the home 

  • 24/7 access to nursing support  

  • A personalized care plan based on individual patient needs and goals 

  • Pain and symptom management 

  • Education for patients and family on the disease or illness and its progression 

  • Support for the physical and mental stress of living with a serious illness 

  • Help with important medical decisions and advanced care planning

     

Outcomes 

  • Identify – Claims-based predictive modeling to identify highest risk members 

  • Quality – Reduce readmissions; improve patient experience 

  • Access – Increase Hospice utilization  

  • Cost – Reduce total cost of care in last year of life 

Meet Coushatta

Coushatta's grandmother

Coushatta’s journey as a caregiver for her grandmother was filled with love but also uncertainty. Struggling with an advanced illness, her grandmother was enrolled in Compassus’ Advanced Care Management (ACM) program.

Listen to Compassus’ innovation with ACM in this podcast: 

Advanced Care Management provides supportive care for those with serious illness diagnoses including: 

  • Cancer 

  • COPD (Chronic obstructive pulmonary disease) 

  • Heart failure 

  • Dementia 

  • Stroke 

  • Advanced kidney disease 

  • Advanced liver disease 

  • General signs of decline (including weight loss, exhaustion, anemia) 

How can we help?

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