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We can bring powerful data and care pathways. We can co-invest in resources, whether they’re nurses, care managers, socialworkers. We also can help them create risk sharing contracts with palliativecare organizations. But as agilon, we don’t provide the care ourselves.
I made a copy of it and gave it to the ICU socialworker to scan for the patient’s electronic chart. In all my years of nursing, this was about as optimal an advance care planning encounter as possible. Because it was the ICU, there were people to witness the form, plus a socialworker to make sure it was scanned into the EMR.
Eric and I are joined today on this podcast by Anne Kelly palliativecaresocialworker to discuss these issues with Liz. Alex: And joining us as she has many times, Anne Kelly is a socialworker at the San Francisco VA. Liz: Yeah, palliativecare teams is exactly one of those institutional factors.
We have our socialworkers and our psychologists and we know how to manage these symptoms. Eric: We just did a podcast on creating palliativecare consults. It was the default palliativecare consult podcast where it was just layered on top of existing palliativecareresources.
So our outpatient palliativecare team does not have psychiatrists or psychologists or frankly, socialworkers. And that’s kind of the model that again, when we’ve studied this model in other care settings, we have to force that care model on them, even though other institutions do have different makeup.
So, basically, with a stepped care model, the goal is to tailor care delivery to the patient’s needs while at the same time utilizing less clinician resources. How it works is that all patients will have access or encounters with the specialty trained clinician, a psychologist, a socialworker, a palliativecare clinician.
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