INSTITUTION
Blue Cross Blue Shield of North Dakota
Fargo, North Dakota
PROGRAM
Blue Cross Blue Shield Hospice
Matters of Life and Death Coalition (MOLD), A State End-of-Life Coalition
DIRECTORS
Jon Rice, MD
Managed Care Medical Director
(701) 282-1048
jon.rice@bcbsnd.com
Mike Hamerlik
Sr. Vice President of Corporate Services
(701) 282-1868
mike.hamerlik@bcbsnd.comkbcbsnd.com
"Death is a touchy subject, especially in this culture. We try to step delicately. In North Dakota it’s a societal issue, and it’s hard to address. This is Lake Woebegone Country."
— Dan Ulmer
Program Mission/Objectives
The mission and objectives of hospice are well known, which is why Blue Cross
Blue Shield of North Dakota is pleased to be a part of the Matters Of Life and
Death Coalition (MOLD). Mike Hamerlik said, "It is not our primary mission to
‘save money’ through the activities of MOLD, but more thoughtful and better use
of resources is a goal."
Program Description & Historical Perspective
The hospice benefit of Blue Cross Blue Shield of North Dakota goes back more
than eleven years. It began, Hamerlik said, in a reactive way, as an offshoot of
Medicare. The hospice benefit parallels the Medicare qualifications. Any person
diagnosed with terminal illness, with a life expectancy of six months or less,
who is a member of any plan, or is self-insured may use the benefit. The hospice
benefit covers all services related to terminal diagnosis. Blue Cross pays a per
diem to the hospice unit for home care, hospice, or respite care. There are no
maximums in the program and no dollar limits; however, families are responsible
for whatever their policy requires. Jon Rice, MD notes that usually people who
get into the hospice program have consumed their deductibles. The hospice
benefit is included in all policies, and all levels of care are available within
that benefit.
Authorization for a patient to enter a hospice program is required through the case management division. A case manager, a nurse, is assigned to work with the family, hospice, Blue Cross and physicians to make sure patient needs are being met.
Blue Cross Blue Shield of North Dakota joined the MOLD coalition, a group of over fifty organizations in North Dakota "committed to improving care given to the dying and their families." The collaborative project is working to develop professional and community educational opportunities, and to identify a continuum of end-of-life care for the people of North Dakota.
The Matters of Life and Death Project began in 1998, when representatives from a broad spectrum of health and social service agencies joined with other interested organizations and individuals to seek ways to improve the quality of life for North Dakota residents.
The coalition is working to find ways to address four key areas of end-of-life care: professional education; continuum of services, access, and finance; public education; and advance care planning. Expertise is drawn from throughout the community to look creatively at ways of addressing these issues.
Education
The MOLD coalition is working to enhance curricula and provide educational
materials for both professionals and students entering fields of health care
delivery. In this way they hope to more effectively address end-of-life issues,
and increase community awareness of existing resources. Their effort
extends to public education through forums, panels, and discussions. One hope is
that with education, physicians will be encouraged to enroll patients in hospice
earlier, so that they will have a better quality to their end of life.
Partnerships
The MOLD coalition is a broad partnership of representatives of
organizations, both public and private, including:
Dan Ulmer, Assistant Vice President of Government Relations, and Jon Rice, Managed Care Medical Director represent Blue Cross Blue Shield in the coalition. Because of their history of delivery of care in hospice, Blue Cross Blue Shield of North Dakota is enthusiastic about joining in the work of the MOLD coalition.
Funding
The MOLD coalition is funded through grants from The Robert Wood Johnson
Foundation, and the Dakota Medical Association.
Vision
The hope for the Matters of Life and Death coalition is that it will ignite
and maintain an interest in finding ways to address issues of quality of
end-of-life care in North Dakota. As Hamerlik said, "the hope is that champions
for these issues will come out of the MOLD coalition." Progress may be
incremental, but it’s still progress. Ulmer noted that the legislature did not
pass a living will law, but they were able to pass a durable power of attorney
law. If working on end-of-life care issues is approached on many fronts,
educationally, legally, and through delivery of appropriate services, the whole
community will benefit.
Key Elements of Success
Measures of Program Success
This descriptive summary is based on an interview conducted by Susan Butler with Mike Hamerlik; Jon Rice, MD; and Dan Ulmer, June 14, 2001.
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