2013 National Summit on Advanced Illness Care

2013 National Summit on Advanced Illness CareA Roadmap for Transformation

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Welcome & Keynote Address

Judith A. Salerno, M.D., M.S., Institute of Medicine

Master of Ceremonies

Lisa Stark, ABC News

Care Journey: Personal Reflections on Advanced Care

ModeratorsRichard Address, Congregation M’Kor Shalom

Tyrone Pitts, Progressive National Baptist Convention

PanelistsAmanda Bennett, Bloomberg News

Nancy Brown, American Heart AssociationSuzanne Mintz, Caregiver Action Network

Susan Reinhard, AARPDon Schumacher, National Hospice and Palliative Care Organization (NHPCO)

Closing RemarksBrad Stuart, M.D., Sutter Care at Home

Care Journey

Patient & Family Videos

Care Journey: Personal Reflections on Advanced Care

ModeratorsRichard Address, Congregation M’Kor Shalom

Tyrone Pitts, Progressive National Baptist Convention

PanelistsAmanda Bennett, Bloomberg News

Nancy Brown, American Heart AssociationSuzanne Mintz, Caregiver Action Network

Susan Reinhard, AARPDon Schumacher, National Hospice and Palliative Care Organization (NHPCO)

Closing RemarksBrad Stuart, M.D., Sutter Care at Home

65 Million Family CaregiversTypical Family Caregiver• 49 year old woman• Cares for a parent who

doesn’t live with her• Provides approx 20

hours of care per week• For about 5 years

1/3 are Higher Burden

• Approx 40 hours of care per week or more

• Lives with Loved One • Provides significant

help both medical and non medical

• Can provide care for 10 years or more

Caregivers Vs. Non-Caregivers • Spend $5,531 more on medical expenses, supplies,

etc.• More likely to

• go part-time• turn down promotions• give up employment

• Over $300,000 in lost income, pensions, SSI• Higher incidence of depression and chronic disease

Poverty, Race, Ethnicity Impact on Health• Lack of Access and Poorer Outcomes

Compared to Whites· Those in poverty 80% · Latinos 60% · Blacks and AI/ANs 40%

2013 National Summit on Advanced Illness Care

A Roadmap for Transformation

Assessing the Benefits and Costs of Transforming Care

ModeratorMark McClellan, Brookings Institution

PanelistsJeff Burnich, M.D., Sutter Medical Network Gail Hunt, National Alliance for Caregiving

Randall S. Krakauer, M.D., Aetna Diane E. Meier, M.D., Center to Advance Palliative Care

Dan Mendelson, Avalere Health

Aetna Compassionate Care Trained, experienced case

managers provide: Case Management Education, support and

resources for the member and their family/caregivers

Pain and symptom management – ensure member has access to effective pain management and ongoing evaluation

Facilitation of informed care decision making – allowing the member/family to actively plan with the case manager and their medical team what their wishes are for continued care

Review what they understand their prognosis to be – Concerns about the path ahead;

making decisions when/if they are unable Planning how to spend their time as options

become limited Review potential trade-offs that may arise over

time Address spiritual and cultural needs as

appropriate

Impact

Favorable impact aligning patient goals with outcomes

82% of engaged decedents choose hospice1

82% reduction in acute inpatient days2

77% reduction in ER visits2

86% reduction in ICU days2

Improved quality of life for Aetna members and their families

15

Member Engagement:the Roots of Impact

Compassionate Care16

•Wife stated member passed away with Hospice. Much emotional support given to spouse. She talked about what a wonderful life they had together, their children, all of the people's lives that he touched - they were married 49 years last Thursday and each year he would give her a piece of jewelry. On Tuesday when she walked into his room he had a gift and card laying on his chest, a beautiful ring that he had their daughter purchase. She was happy he gave it to her on Tuesday - on Thursday he was not alert. She stated through his business he touched many peoples lives, and they all somehow knew he was sick, and he has received many flowers, meals, fruit, cakes - she stated her lawn had become overgrown and the landscaper came and cleaned up the entire property, planted over 50 mums, placed cornstalks and pumpkins all around. She said she is so grateful for the outpouring of love. Also stated that Hospice was wonderful, as well as everyone at the doctors office, and everyone here at Aetna. {She tells all of her friends that "when you are part of Aetna, you have a lifeline.”} Encouraged her to call CM with any issues or concerns. Closed to Case Management.

Barriers and Solutions• Inability to Identify cases

• Members with Advanced Illness are not engaged in support in a timely manner

• Insufficient communication between case managers and physicians and staff

• Hospice eligibility criteria represent unnecessary barrier

• ID Algorithm, work with physicians to ID cases

• Case manager initiates outreach after verifying case with physician

• Case managers embedded in medical offices

• Liberalize Hospice entry criteria – concurrent care and 12 month course

Avalere Health LLC | The intersection of business strategy and public policy

Using Patient Flow Data to Manage Risk, Enhance Patient Outcomes, and Improve Financial Performance /

Dan MendelsonFebruary 2013

© Avalere Health LLCPage 19

Breaking the Readmission Cycle /Improving Care Coordination Across Continuum of Care

Sick Patient

Hospital Rehabilitation & Nursing Facilities

Home

Lack of communication, medication management, patient preparation, and

follow-up care

Health status deteriorates / Patient readmitted

Success in coordinating care and allocating revenue will demand new affiliationsand new capital investment strategies


Patient Flow Patterns /Where Do Patients Go After Hospital Discharge?

Medicare

LTACH

1%

IRF

3%

SNF

18%

HHA

9%

Home

55%

Other

14%

Emergency Department

(19%)

Readmissions

(17%)

What happens to a patient during the post-discharge period is very important / 19% of patients go to the emergency department, and an additional 17% are readmitted

for care that could have been provided in less intensive settings, including home

Transition

PAC: Post-Acute Care; LTACH: Long-Term Acute Care Hospital; IRF: Inpatient Rehabilitation Facility; SNF: Skilled Nursing Facility; ALF: Assisted Living Facility; HH: Home Health*The remaining 14% of Medicare patients discharged from hospitals either are discharged to other (e.g., another inpatient hospital) or die. Source: Avalere analysis of 2009 Medicare 100 Percent Standard Analytic File (SAF) claims data base from the Centers for Medicare and Medicaid Services (CMS). Beneficiaries may be counted more than once because they may have multiple hospital admissions during 2009.


Readmissions /National Readmission Rates for Common Conditions

Additional Avalere ConditionsDiabetes Alzheimer’s CancerStrokeHeart DiseaseMajor JointCKDPneumonia*EndocrineVent CareInfectious DiseasePulmonarySpinal Fusion Back ProblemsNeurologyGI Disorders

Source: Avalere Vantage CPS (Medicare SAFs 2010)The Avalere Pneumonia measure includes a broader set of pneumonia cases (pneumonia secondary to another condition and pneumonia-like conditions) than the CMS PN measure

CMS HRRP Conditions MedPAC Select Conditions


Readmissions for AMI /Across Patients’ Next Site of Care

Readmission rates differ significantly based on the next site of care—Risk adjustment is key for understanding differences in readmission rates

Source: Avalere Vantage CPS (Medicare SAFs 2010)


Patient Flow Patterns /Henry Ford Hospital’s Current Local Market Referral Network

Henry Ford Hospital- Macomb

RA-RR = 20.0%

Henry Ford Hospital - Macomb-IRF St. John Home Care (HHA)

Shelby Nursing Center (SNF)

Medilodge of Sterling Hts.(SNF)

CVS Caremark MinuteClinic/ HFHS Clinical

AffiliationMichigan Area

Agency on Aging 1B(CMMI CCTP)

33.2%

23.9%22.8%

7.2%

20.7% 19.4%

2.0%21.1%

Source: Data powered by Vantage CPS; Medicare Nursing Home Compare (NH) and Medicare Home Health (HH) CompareNote: These readmission rates have not been risk-adjusted

Represent Overall Star Rating based on NH Compare and HH CompareComposite Rating calculated based on 5 select HH Compare measures (i.e., patient education, falls risk, HF symptoms, pressure ulcers, wounds)

Composite Rating 89%


Patient Flow Patterns /Henry Ford Hospital’s Recommended Local Market Referral Network

Henry Ford Hospital-Macomb

RA-RR < 20.0%

St. John Home Care

(HHA)

Michigan Area Agency on Aging 1B

(CMMI CCTP)

22.8%7.2%

19.4%

2.0%Bay Nursing Inc.

(HHA)16.8%

7.0%

Henry Ford Cont. Care Ctr. (SNF)

14.6%

3.8%

HFH-M-IRF 20.7%

21.1%

CVS Caremark MinuteClinic/ HFHS Clinical

Affiliation

Shelby Nursing Center(SNF)

33.2%

23.9%

Medilodge of Sterling Hts. (SNF)

Composite Rating 99.4%

Source: Data powered by Vantage CPS; Medicare Nursing Home Compare (NH) and Medicare Home Health (HH) CompareNote: These readmission rates have not been risk-adjusted

Represent Overall Star Rating based on NH Compare and HH CompareComposite Rating calculated based on 5 select HH Compare measures (i.e., patient education, falls risk, HF symptoms, pressure ulcers, wounds)


Patient Flow Analysis and Data Analytics /Focus in Transitional / FFS Environments

Identify hospitals with high readmission rates

Identify patients with high-risk of readmission or ED utilization

Understanding performance on activities that affect payment

Reduce readmissions

Reduce ED utilization

Increase physician visits

Improve medication adherence

Improve patient and caregiver satisfaction

Reduce readmissions, ED visits, and other expensive inpatient care

Substitute to higher quality/ cost-effective PAC/ LTC settings

Reduce per capita cost

Manage Risk

Enhance PatientOutcomes

Improve FinancialPerformance



Having Your Own Say

Jeff Thompson, MD Chief Executive Officer

About us... Integrated Delivery System – Approximately 6,300 Total Employees

– 768 providers employed / 484 medical

staff – 51 clinic locations

– 325-bed Tertiary Medical Center

Western Campus of the University of Wisconsin

Medical & Nursing School

Gundersen Lutheran Medical Foundation Residency and Medical Education Programs

Research Program

Many affiliate organizations including EMS air and ground

ambulance service, rural hospitals, nursing homes, hospice, etc.

$866.2 million Operating Budget

Physician-led organization

Strong Administrative/Medical partnership

cialgaT Strategic Plan 2012-2016

Mission: We will distinguish ourselves

through excellence in patient care, education,

research and improved health in the communities we serve.

Vision: We will be a Health System of excellence, nationally recognized for improving the health and well-being of our patients, families,

and their communities.

Commitment: We will deliver high quality care because lives depend on it, service as though the patient were a loved one, and

relentless improvement because our future depends on it.

Values: integrity — Perform with honesty, responsibility and transparency.

Excellence — Measure and achieve excellence in all aspects of delivering healthcare.

Respect — Treat patients, families, and coworkers with dignity.

Innovation — Embrace change and contribute new ideas.

Compassion — Provide compassionate care to patients and families.

Our Purpose is to bring health and

well-being to our patients and communities.

Superior

Quality

and Safety Demonstrate

superior

Outstanding

Patient

Experience Create an

outstanding

Great Place

Create a Culture

that embraces a

passion for caring

and a spirit of

improvement

Affordability

Make our care more

Affordable to our

patients, employers,

and i-nrrtrniirsifti Liu LAU! Ly

Growth

Achieve Growth

that supports our

mission and other

key strategies ou uusi.up Quality & Safety Experience

through the eyes for patients of the patients & and families caregivers

“We all die. A fundamental question is do we want to have a say in how we live?”

Jeff Thompson, MD

Having Your Own Say Getting the Right Care When It Matters Most

Gundersen Health System

4

“In most respects, the patient were like those

found in any ICU...yet these patients were

completely different.”

“None had terminal disease, none battled

metastatic cancer, or had untreatable heart

failure or dementia.”

Atul Gawande, The New Yorker, August 2, 2010

5

“But in La Crosse, the system means that people

are far more likely to have talked about what

they want and what they don’t want before they

and their relatives find themselves in the throes

of crisis and fear. When wishes aren’t clear,

families have also become much more receptive

to having the discussion.”

By Atul Gawande, The New Yorker, August 2, 2010

6

“Discussion had brought La Crosse’s end-of-life

costs down to just over half the national

average. It was that simple – and that

complicated.”

Atul Gawande, The New Yorker, August 2, 2010

7

Patient and Family

Evaluation

Hospital Satisfaction 90th percentile Clinic Satisfaction 90th

percentile

Gundersen Medicare 5 Star 75% Market Share

Advantage Program

Our Plan...

Advanced planning

Integrated delivery system

Available health record

Community collaboration

Not for profit mission

9

Four Key Elements in Designing

an Effective ACP Program

#1 Systems Design

#2 ACP Facilitation Skills Training

#3Community Education and Engagement

#4 Continuous Quality Improvement

La Crosse Compared to

National Averages

100

90

80

70

60

50

40

30

20

La Crosse

Nationally

10

0

% of severely or terminally ill patient

with an advance care plan

Consistency between known care plan and treatment provided

% of physicians who are aware of the

advance care plan

J Am Geriatr Soc 2010;58:1249–1255. 11

Australian Study Cont’

Outcomes when Subjects Died

Intervention Control P value

n (%) 29 (19) 27 (17) 0.75

Age median, (IQR) 85 (84-89) 84(81-87) 0.06

Sex, male n (%) 17 (59) 13 (48) 0.43

Patients completed ACP 25 (86) 0 (0) <0.001

Wishes known and followed 25 (86) 8 (30) <0.001

Wishes unknown 3 (10) 17 (63) <0.001

Effect on family Impact of Event Score: median

5 (2-5.5) 15 (5-21) <0.001

Effect on family Hospital Depression Scale

0 (0-1.5) 5 (0-9) <0.001

BMJ 2010;340:c1345

Value of Advanced

Care Planning

Value of respecting or honoring a patient’s values and goals

Avoiding treatments the patient considers burdensome, thus avoiding unnecessary suffering and indignity

Being better able to provide care where the person would want it

Diminishing or eliminating the moral distress and its lasting effects experienced by family or medical staff members who must make healthcare decisions when they do not know what the patient would want

13

How do we make integrated

healthcare really work?

Preserving your health

Heavy investment in primary care, disease management and rehabilitation

Multiple layers of connectivity Electronic Health Record, Best Practice Protocols, Shared Education Program

Electronic fetal monitoring sites, ER Telemedicine real-time hookup

Focus on saving lives and preserving function Extended TEC/Continuum of care

The critical care hospital of the future

15

Our Care

Coordination Plan

Nurses and Social Workers collaborating with

multiple providers, and between patients and

families to coordinate services and resources

across continuum of health care to assist

patients in reaching their optimal health.

The Care Coordination Program works with

patients of all ages and is a service provided at

no cost to patients.

16

Care Coordination Program

Out-Patient We take care of FFS

Management patients the same as

those for whom we are

at financial risk

Average caseload is 1,200

patients

lee "To heal the patient, heal the system."

Brad Stuart, MD, CMO

Sutter Care at Home

GUNDERSEN HEALTH SYSIFEM

Electronic Health Record Connectivity

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"We all die. A fundamental question is do we

want to have a say in how we live?"

Jeff Thompson, MD


Jeff Thompson, MD

Chief Executive Officer

www.gundluth.org

Appendix

National Recognition

System-Wide Recognition Top 100 Hospitals Five Year Performance Improvement Leader – Thomson Reuters

HealthGrades Distinguished Hospital Award for Clinical Excellence

– Places Gundersen Lutheran in the top 5% of hospitals in the nation 6 times

Top 100 Hospital – Thomson Reuters Top 100 Integrated Healthcare Network – Verispan 2009 Dartmouth/IHI/Brookings – Best value of 309 Medicare regions

2009 Commonwealth Fund Top Integrated Systems in U.S. 2010 Delta Group – Ranked # 1 of 118 academic centers 2011 Top 1% in HealthGrades outcomes

Cost of Care in the Last

Two Years of Life

Hospital Days/Patient Total Cost of Care/Patient

Hospital in Last 2 Years of Life During Last 2 Years of Life

Gundersen Lutheran 13.5 $18,359

Marshfield/St. Josephs 20.6 $23,249

University of Wisconsin 19.7 $28,827

Cleveland Clinic 23.9 $31,252

Mayo Clinic 21.3 $31,816

UCLA 31.3 $58,557

University of Miami Hospital & Clinics 39.3 $63,821

New York University Medical Center 54.3 $65,660

* Based on 2007 Dartmouth Atlas Study Methodology. The Dartmouth Atlas methodology examines hospital inpatient care for the last

two years of a Medicare patient’s life.

Stages of Advance Care Planning Over the Life Time of Adults

First Steps Next Steps Last Steps ACP: Create POAHC and consider ACP: Determine what

ACP: Establish a

plan of care when a serious neurological injury would change goals of treatment.

goals of treatment should be followed if complications result in “bad” outcomes.

specific expressed in medical orders using the POLST

paradigm.

Healthy adults between ages 55 and 65. Adults with progressive, life-limiting illness, suffering

frequent complications

Adults whom it would not be a surprise if they died in

the next 12 months.

POLST

Physician

Order for

Life

Sustaining

Treatment

27

Lessons for Healthcare Systems

Almost all patients and families are willing to consider and talk about future medical decisions IF they see how this effort will improve their own treatment....we

must be able to explain the benefits of the effort of having the conversation to the patient/family.

A standardized, patient-center, staged approach to these advance care planning conversations is crucial (rather than a legalistic approach).

An organized system of work flows, processes, and EMR is needed in all health care settings. The effort of ACP must be built into the routine of care and shown that it improves patient outcomes.

28

Lessons for

Healthcare Systems

To be successful with ACP requires the

understanding, support, and involvement of the

whole community and the other institutions that

hold the community together: religious;

business; government; schools; service groups.

In order to actually honor the preferences and

goals of patients/families at the end of life, we

need a delivery system that is more versatile that

can be individualized to the patient’s goals and

health condition.

29

Lessons for

Healthcare Systems

The health organizations need to develop the “capacity” to assist patients with ACP and to honor plans before any public engagement.

Health organization should involve leaders from other organizations/institutions relatively early in this work and get these leaders on board.

Perhaps two years into the effort, the public at large need to be engaged about the value of this work for them knowing that all major institutions/leaders are supportive.

30

Lessons for Healthcare Systems

This approach not only insulates health organizations from negative attacks, but can create a more positive image of health care.

The evidence shows that families who face complex, moral/medical decisions are better prepared with effective advance care planning and deal with grief in a healthier way (fewer complications). One might assume that this leads to not only positive feelings toward the health organization who provide end of life care, but also to fewer missed days at work.

31

Definition: Advance

Directive (AD)

A plan, made by a capable person or their

surrogate, for future medical care regarding

treatments or goals of care for a possible or

probable event.

This plan could be expressed:

Orally or in writing

If written, it could be in strict accord with specific state statutes or simply a documentation of the plan, e.g., a physician’s note.

Definition: Advance

Care Planning (ACP)

A process of planning for future medical

decisions. This process, to be effective, needs

to meet similar standards as the process of

informed consent, i.e., the person planning

needs to... – Understand selected possible future situations and

choices;

– Reason and reflect about what is best; and

– Discuss these choices and plans with those who might need to carry out the plan

Relationship of

ACP to ADs

ADs are only as good as the process of planning:

If the person planning does not understand,

reflect on, or discuss their choices/options adequately, the plan has a high probability of

failure.

ADs success is directly tied to the quality of

the planning process or ACP.

Family Member...

“I just want to thank you again for helping my

Dad. The meeting was just what we needed. It

would have been difficult to broach those

subjects without you there to facilitate. I think

his mind was put to ease by getting everything

out in the open and it led to some very

productive and loving conversations later in the

day.”

35

Participating

Organizations

AARP Aetna Amedisys

Center to Advance Palliative Care Coalition to Transform Advanced Care (C-TAC) Dartmouth Institute for Health Policy and Clinical

Practice Gundersen Health System Honoring Choices Minnesota National Palliative Care Research Center Respecting Patient Choices, Australia Sutter Health/Sutter Care at Home

36

C TAC’s Four Key

Areas of Focus Do what works: promote best practice care delivery (the models that work in clinical and community settings) to ensure high-quality, coordinated advanced illness care, across all settings;

Empower the public: help people to understand and make informed choices for themselves and their families and to call for change in care delivery and in policies;

Educate health professionals: to better serve patients and

families/caregivers so people know their options, make informed

choices, get the care they need, and avoid procedures they don’t

want;

Create policy change: develop and advocate for federal and state

legislative, regulatory, judicial, and administrative initiatives, and also

for private policies, to improve care for those with advanced illness.

37

“La Crosse is Unique”

Not so...

Minneapolis-St. Paul, Medical Society, Allina,

Health East, Park Nicollet

Honoring Choices Minnesota

38

HCM Engagement In

the Community To Demystify...taboo issues related to the death

and dying processes in the 21st Century;

To Inspire...Minnesotans to imagine becoming more involved in the end-of-life care decision-

making process;

To Model...ways in which families can discuss and embrace end-of-life care planning;

To Support...families with an online “toolkit” of video and text tools; and

To Prepare...caregivers and families alike to make certain that family choices are always honored.

39

Australian Experience

Same Model

Same Outcomes as U.S.


British Medical

Journal, March 2010

“Systematized model of advance care planning, following the principles established by Respecting Choices; could significantly improve”

Patient and family satisfaction regarding care

Improve the knowledge of and respect for patients’ end-of-life wishes

Contribute to the quality of the end-of-life care

Reduce the incidence of clinically significant anxiety, depression and post-traumatic stress disorder in the surviving relatives of deceased patients

41

Advanced Directives/POLST

Care Coordination

Palliative Care

Advanced Disease Coordination

42

The Washington Context: Policy Opportunities to Improve Advanced

Illness Care Moderator

Bruce Chernof, The SCAN Foundation

PanelistsHanns Kuttner, The Hudson Institute

Chris Jennings, Jennings Policy StrategiesSenator Blanche Lincoln (D-AR), Alston & Bird

Len Nichols, George Mason University

Perspectives From the U.S. Senate: Achieving High Quality Advanced

Illness Care for Our SeniorsModerator

Susan Dentzer, Health Affairs

PanelistsU.S. Senator Johnny Isakson (R-GA)

U.S. Senator Ron Johnson (R-WI)U.S. Senator Mark Warner (D-VA)

U.S. Senator Sheldon Whitehouse (D-RI)

Closing Remarks

Leonard D. Schaeffer, University of Southern California



Keynote AddressSpeaker

Kathy Greenlee, Assistant Secretary for Aging, and Administrator, Administration for Community Living, U.S. Department of

Health and Human Services

Empowering the Public to Make Informed Decisions and Plans

ModeratorAlexandra Drane, Eliza Corporation

Opening SpeakerKent Wilson, M.D., Honoring Choices Minnesota

PanelistsAmy Berman, The John A. Hartford Foundation

Lindsay Hunt, Institute for Healthcare Improvement/The Conversation Project Peg Chemberlin, National Council of Churches

Terry Clark, UnitedHealthBill Hanley, Twin Cities Public Television (TPT)

“Honoring Choices MN”

Twin Cities Medical Society&

Twin Cities Public Television


What We Set Out to Do …

•Change Societal Attitudes - Needed to be simple

•Family Conversations–No Documents Required


What We Needed…

•Broad Public Awareness: - 6 Full Docs, PSA’s, Web, Social Media, Newspapers

•Human Story-Telling: Authenticity, Humor

•Diversity: Faith, Culture, Identity

•Direct Engagement: Listening Sessions, Ambassadors

•Long-Term Commitment: Seven (7) Full Years


How We Approached It …

•TCMS Laid Groundwork: with Medical Colleagues

•Public TV: Asked to Design, Plan, Budget

•Partnership: Shared Costs, Control, Copyright, Fund-raising

•Plan, Revise, Go Again•Corporate “Lead”: CEO, Health Partners

•Enlist other Media: TV, Radio, Newspapers, Social Media


Progress to Date …

•Broadcasts (Docs & Spots): 700+

•Web Usage: 22,000 Videos

•Comm. Engagement: 38 Ambassadors, 100 Trainings

•2011-12: Viewed as “Broadly Effective”

•2013-17: Public TV will Continue to Broadcast


Twin Cities Medical Society&

Twin Cities Public Television

Empowering the Public to Make Informed Decisions and

Plans

Mario's Story

Catalyst, convener, coordinatorTwin Cities Medical Society

Physician membership organizationRepresenting over 5,000 physicians

Our Focus2008-2010 --St. Paul/Minneapolis; 2.7 million 2010-present—statewide – 5 million

Mission

To promote the benefits and implement processes and methods of advance care planning to the community at large

Timeline+

Impact1. 26 hospitals/health care systems2. 600 community based partners3. 45 volunteer Ambassadors trained; hundreds of

presentations given4. Nearly 1,000 Facilitators trained to have

discussions with individuals and families; 50 Instructors

5. Documentaries air 90+ times; PSAs over 900 times

6. 15,700 health care directives downloaded in the last 18 months.

Lessons learnedCollaboration is essentialLocal oversight and governance is necessaryCommunity wants to be engaged in this workBroad based public engagement tactics are

needed

Contact InformationKent Wilson, MD Sue SchettleMedical Director Chief Executive OfficerHonoring Choices MN Twin Cities Medical Society

[email protected] [email protected]

612-362-3704 612 -362-3799

mailto:[email protected]

Working Together: Innovations in Inter-Professional Training

ModeratorsDavid E. Longnecker, M.D., Association of American Medical Colleges Washington

DCCynda Rushton, PhD, RN, FAAN, Johns Hopkins University

PanelistsPatricia A. Grady, PhD, RN, FAAN, National Institute of Nursing Research

Bud Hammes, Gundersen Health SystemRichard Payne, Duke Institute for Care at the End of Life

Bob Wolf, Healthcare Chaplaincy

Care Planning and

Advanced Illness Management

Bernard “Bud” Hammes, PhDDirector of Medical Humanities

Gundersen Health SystemLa Crosse, WI

www.respectingchoices.org

Fragmentation of Care

People with advanced illness suffer greatly because our current system is fragmented:1.In space…from one setting to another we don’t share a common plan/approach;2.Over time…we don’t keep in tune with individuals changing goals of care;3.By protocol…we provide treatment approaches that are inflexible and at time either/or.

Credit to Brad Stuart, MD.

Correcting Fragmentation Requires:

1. A care model that puts the ill person at the center of the care model; and

2. A care team that can deliver this model through time and a cross settings of care in a way that meets the individual goals of each person.

A new care model for those with advanced illness requires:

• Care planning build into the routine of care• Care planning is achieved by well organized,

effective conversations with individuals (and those close to them) and are updated over time

• Care planning leads to clear plans• Care plans are always available to providers • Care plans are used thoughtfully when needed• The individual care plans can be met by a flexible

care system where treatments provided are consistent with treatments desired

Designing this new model requires

1. We change our approach to the process of care planning…we need a staged approach;

2. We need some fundamental redesign of the care system.

Last StepsACP: Establish a specific plan of care expressed in medical orders using the POLST paradigm.

Adults whom it would not be a surprise if they died in the next

12 months.

Next StepsACP: Determine what goals of treatment should be followed if complications result in “bad” outcomes.

Adults with progressive,life-limiting illness, suffering

frequent complications

First StepsACP: Create POAHC and consider when a serious, permanent neurological injury would change goals of treatment.

Healthy adults between ages 55 and 65 or anyone younger with a serious illness

Stages of Advance Care Planning Over the Life Time of Adults

We also need to…

• Redesign specific workflows, roles, and tools in the health system;

• Train health professionals to conduct the care planning conversations at each stage and to work as a team;

• Provide community engagement;• Improve these new systems through

continuous performance improvement.

For more information about this approach go to:

www.havingyourownsay.org.

Integrating Spiritual Care to Transform

Advanced CareBob Wolf – HealthCare Chaplaincy

Definition - Spiritual Care

Interventions, individual or communal, that facilitate the ability to express the integration of the body, mind, and spirit to achieve wholeness, health, and a sense of connection to self, others, and[/or] a higher power.

American Nurses Association, & Health Ministries Association. (2005). Faith and community nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association.

Existential Questions:

• Every human being has a spiritual dimension

• Every human being faces mortality

• Mortality is challenging

© HealthCare Chaplaincy#

•WAS I BORN?

•MUST I DIE?

•AM I HERE?

WHY???

Faith: Letting Go – Moving On

© HealthCare Chaplaincy#

The NCP Guidelines Address Eight Domains of Care:

Structure and processes Physical aspects Psychological and psychiatric

aspects Social aspects Spiritual, religious, and

existential aspects Cultural aspects Imminent death Ethical and legal aspects

Existential Equanimity

• A state of being that accepts mortality with

equanimity– Drives decisions about care of serious

and life-limiting illness• Compatible with attempts to cure or to

exclusively pursue palliation– Drives relationships with loved ones• Determinant of grief and bereavement

course among family© HealthCare Chaplaincy104

Spiritual Support & Cancer

In a large study of advanced cancer patients:

88% said religion was at least somewhat important 72% said their spiritual needs were minimally or not

at all supported by the medical system 42% said their spiritual needs were minimally or not

at all supported by their faith community. Spiritual support was highly associated with QOL.

(P=.0003)

Balboni, et al. (2007). Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life. Journal of Clinical Oncology, 25(5), 555-560.

© HealthCare Chaplaincy106

From the fight against polio to fixing education, what's missing is often good measurement and a commitment to follow the data. Wall Street Journal – Saturday January 26th 2013

Bill Gates: My Plan to Fix The World's Biggest Problems:

Spiritual Screening

Is religion/spirituality important to you as you cope with your illness?

How much strength/comfort do you get from your religion/spirituality right now?

Has there ever been a time when religion/spirituality was important to you?

Fitchett, G and Risk, J. L. (2009). Screening for spiritual struggle. Journal of Pastoral Care and Counseling, 62 (1, 2), 1-11

F Do you have a spiritual belief? Faith? Do you have spiritual beliefs that help you cope with stress/what you are going through/ in hard times? What gives your life meaning?

I Are these beliefs important to you? How do they influence you in how you care for yourself?

C Are you part of a spiritual or religious community?

A How would you like your healthcare provider to address these issues with you?© C.Puchalski

Spiritual History

DAME CICELY SAUNDERS, OM, DBE, FRCP, FRCNFOUNDER AND PRESIDENT

ST CHRISTOPHER’S HOSPICE22 June 1918 - 14 July 2005

physical

social psychological

spiritual

The spiritual life provides an integrative function, working through attribution of meaning to connect our existence to the grand narrative of existence.

Cicely Saunder’s implied postulate?

© HealthCare Chaplaincy110

TEAMGoals of Care

Train Chaplains

Train Doctors and Nurses

Research literate

Palliative Competencies

Spiritual Needs/Assessment

What Gets in the Way:

“I’m all for progress. It’s change I object to.”

-Mark Twain



Identifying and Replicating Best Practices in Clinical and Community Models

ModeratorTom Smith, Johns Hopkins University

PanelistsEric Anderson, Allina Health System

Bill Borne, AmedisysMalene Davis, Hospice Innovations Group

Dan Johnson, Kaiser Permanente

114

“As I live well with serious illness, I am in charge. You listen to me, help me, guide me, honor me, and support me as a person.”

LifeCourse

Center for HealthcareResearch & Innovation

1. Ongoing, personal relationship with a non-clinical Care Guide

2. Interdisciplinary Team to address all domains of palliative care and coordinate across care settings and care partners

3. A complement to existing services and to the existing strengths and assets of the individual and caregivers

Inflection Disruption Early Adoption

Facilities

Advanced CareManagement

The community-based delivery model is standardized.

The interface differs according to the anchor

in the community.

Health Care @ Home

Kaiser Permanente

• Integrated health system, 8 regions + D.O.C.• Advanced illness care grounded in 3 RCTs• Strategies: INVEST, EDUCATE, and INTEGRATE

• Access to specialty-trained palliative support across inpatient, home, clinic and NH settings

• Systematic approaches to care planning (e.g., Respecting Choices)• Moving away from “referral-only” models; imbedding specialty

support in high risk settings • Developing complex medical homes for most seriously ill

The Innovations Group

• What is the Innovations Group?• Additional examples of care

coordination.• Hospice as a foundational model of

community-based interdisciplinary care.

• Advanced Illness---The Next Generation!

The Innovations Group

• Hope HealthCare Services

• Valley Hospice

• Hospice of the Bluegrass

• Four Seasons

• Hospice of Michigan

• Chapters Health System

• Hospice of Palm Beach County

• Nathan Adelson Hospice

• Home & Hospice Care of Rhode Island

• Sutter Care at Home

• Capital Caring

• The Elizabeth Hospice

• Covenant Hospice

• Hosparus

• Suncoast Hospice

• Midwest Palliative & Hospice CareCenter

• HopeHealth

• The Denver Hospice

• Hospice of Chattanooga

• Hospice & Palliative Care of Western Colorado

* The NHWG CEO participates as an invited member and an advisor

The Innovations GroupThe Innovations Group Hospices Leverage Core Competencies for Advanced IllnessHospices Leverage Core Competencies for Advanced Illness

COMPREHENSIVE COORDINATED ADVANCED ILLNESS CARECOMPREHENSIVE COORDINATED ADVANCED ILLNESS CARE

Disease Modifying Interventions*

Interventions with Curative

Capacity*

Palliative Interventions

Bereavement

Diagnosis of a serious or chronic

condition

Prognosis of foreseeable limited life expectancy or

end-stage disease

Death

Adapted from: Fine PG, Davis M. Fine PG, Davis M: 2006. Hospice: comprehensive care at the end of life. Anesthesiol Clin;24(1):181-204.

Consumer Education, “Coaching”, Empowerment

AL = Assisted Living LTC = Long Term Care * until no longer meeting medically specified outcomes or patient’s goals

H o s p i c e

There are opportunities to improve our practice on hospice referrals

The benefits are straightforward…better care, and people who use hospice for even one day live longer.

Connor SR, et al. J Pain Symptom Manage. 2007 Mar;33(3):238-46.

We miss opportunities to recognize hospice eligible patients, they are readmitted, and

cost more.

U of Iowa Hospitals. •688 in-hospital deaths •209 decedents had preceding admission •60% of decedents were eligible for hospice on the penultimate admission, based on NHPCO, National Hospice and Palliative Care Organization worksheets.

-Only 14% had any discussion of hospice, despite being eligible; 14 of 17 enrolled, all from ONE service

Freund K, et al. J Hosp Med. 2012 Mar;7(3):218-23. doi: 10.1002/jhm.975. Epub 2011 Nov 15.

We miss opportunities to recognize hospice-eligible patients, they are readmitted, and cost more.

Table: Comparison of Cost and Length of Stay Between Patients Enrolled and Not Enrolled in Hospice During a Terminal Hospital

AdmissionEnrolled in hospice before last

admission n = 7/14Not enrolled in hospice, all

diagnoses, n = 202/209

Cost Mean $4963 $52 219 Median $3690 $23 322 Standard deviation

$3250 $85 101

Standard deviation

4.47 25.05

Palliative Care Consultation YES, $41,859 NO, $58,386P<0.04

Freund K, et al. J Hosp Med. 2012 Mar;7(3):218-23. doi: 10.1002/jhm.975. Epub 2011 Nov 15.Weckmann MT, et al. Am J Hosp Palliat Care. 2012 Sep 5.

People who use hospice are re-admitted less often, use less medical resources, and get

better care.

Enguidanos S, Vesper E, Lorenz K. 30-Day Readmissions among Seriously Ill Older Adults. J Palliat Med. 2012 Dec;15(12):1356-61. doi: 10.1089/jpm.2012.0259. Epub 2012 Oct 9.

Table 2. Readmission Rate by Post-discharge Medical Service Use Post-discharge medical services Ratio of readmissions Percent Hospice 11/240 4.6 Home-based palliative care 5/60 8.3 Home health 2/15 13.3 Nursing facility 14/58 24.1 Home no care 9/35 25.7

Hospice saves Medicare $2309 per decedent, and the longer the hospiceLength of stay, the bigger the savings. Taylor DH Jr, Ostermann J, Van Houtven CH, Tulsky JA, Steinhauser K. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Soc Sci Med. 2007 Oct;65(7):1466-78. Epub 2007 Jun 27.

Better care, consistent with what people would choose. Smith TJ, Schnipper LJ. The American Society of Clinical Oncology program to improve end-of-life care. J Palliat Med. 1998 Fall;1(3):221-30.

Hospice eligibility is straightforward – take out your smart phones and Ap this!

• The SURPRISE QUESTION: “Would you be surprised if this person were to die in the next 6 months?”

• Failure to thrive: BMI < 22, involuntary weight loss

• CHF NYHA Class IV, EF < 20%• COPD: hypoxemia at rest, FEV1 < 30%• Dementia < 6 words• Liver disease: INR > 1.5, albumin < 2.5• Cancer – much easier. Salpeter et al.

J Palliat Med. 2012 Feb;15(2):175-85. Prognoses < 6 months.

http://www.nationalhealthcaredecisionsday.org/

Identifying hospice eligible patients makes a difference

PC program

How do we better integrate hospice into our care?

• Have a “hospice information visit” when we think the person has 3-12 months to live.

• Can’t hurt. OK to predict wrongly.• Can dramatically help

• Makes us address difficult issues like “code status”• Informs family that the situation is serious and their

loved one is dying (moves the angst upstream)• MOLST• Will, Living Will, DPMA, Life Review, Dignity therapy

Smith TJ, Longo DL. Talking with patients about dying. N Engl J Med. 2012 Oct 25;367(17):1651-2. doi: 10.1056/NEJMe1211160.

Barriers•Provider Competition•Challenges to System Integration•Lack of Incentives•New Training Needs•Startup Costs•Reimbursement•Unique Local Issues

Opportunities•Payer-Provider Collaboration•Private Sector Leadership•National Scale Pilots•Common Metrics•Comparative Data Analysis•Payment Reform Advocacy•Model Flexibility

Key Barriers and Solutions to Innovations in Advanced Illness Care & Management

Questions

Breakout SessionModerators

Randall S. Krakauer, M.D., AetnaBrad Stuart, M.D., Sutter Care at Home

NAS 125

Empowering Employers as Part of the Solution

ModeratorBrent Pawlecki, The Goodyear Tire and Rubber Company

PanelistsAnn Richardson Berkey, McKesson Corp.

Neil Trautwein, National Retail FederationJack Watters, Pfizer

Pam Kalen, National Business Group on HealthKathy Brandt, National Hospice Palliative Care Organization

Advanced Illness and Caregiving:A workforce challenge

Brent Pawlecki, MD, MMMChief Health OfficerThe Goodyear Tire & Rubber Company

National Summit on Advanced Illness CareJanuary 30, 2013

136

The Goodyear Tire & Rubber Company

136

Consumer

• Goodyear is one of the world's leading tire companies.○ Goodyear is the No. 1 tire maker in North America and Latin America.○ Goodyear is Europe's second largest tire maker. ○ The world’s largest operator of commercial truck service and tire retreading

centers.○ Operates approximately 1,500 tire and auto service center outlets.

• Founded in 1898 in Akron, Ohio.

• 2011 annual sales of $22.8 billion.

• Employs approximately 73,000 people around the world.

• Operates 54 plants in 22 countries.

• Blimps—our aerial ambassadors since 1925. ○ Goodyear operates three blimps in North America.

Global Health Services

• Building the Culture of Health

– Health Benefits

– Wellness Programs

– Environment, Health and Safety

– Emergency Preparedness

137

Healthy, Engaged,

Productive Employees

Global Health Services

138

Goal:

Preventing illness.

When prevention is not possible, securing the right care at the right place at the right time.

When treatment is no longer possible, assuring that people have the tools available to support a dignified and respectful end of life.

Maximize the health and wellbeing of our associates, control benefits costs and improve productivity by:

好生活, 生活好选择

Advanced Illness / End of Life

• Americans living with advanced illness and their caregivers

– Are not asked what care they want

– Are not given the help to make good decisions about coordinated high quality care

– Creates physical, emotional and financial hardships

Coalition to Transform Advanced Care (C-TAC)

Workforce Challenge—advanced illness

Why it is an employer issue

1. Employees are caregivers

– Demographic shifts

• One in five will be 65 and older by 2030

• percentage of working age 18 - 64 declining

– Caregiver duties

• 7 to 10 million adults care for parents from distance

• 25% of adults provide care to another adult

• 64% of caregivers work full or part-time

• 1 in 8 aged 40 – 60 care for both parent and child

• roughly half were men




– Productivity & financial impact (2006 MetLife)

• $17.1 to 33.6 billion per year

• Workday interruption at least one hour per week

• 60% needed to attend to some crisis

• 2.4 percent leave workforce entirely

• Cost for full-time employed caregiver $2,110

• Uncaptured presenteeism costs




– Unprepared

• fewer than half of baby boomers have discussed their parents’ treatment wishes in the event of terminal illness

• only 40% have discussed their parents’ will

– Adverse health effects (2010 MetLife)

• 8% increased health care expenses—13.4 billion/yr

– Leaving workforce

• Leave of absence (survey showed roughly 25% of caregivers considering and/or planning for it)



2. Unexpected health crisis for employee or partner

– 627,000 working age adults die each year

– 2007, unintentional injuries caused 120,000 deaths and 26 million disabling injuries

– Undocumented end of life issues

• Treatment decision confusion

• Emotional burden

• Mounting medical and disability costs



3. Childhood health issues

– Parents / Grandparents as caregivers

• Balance needs of other family members, household, jobs

• Travel to specialty centers

– Prematurity

• One in eight in U.S., often with serious health conditions

• First year medical costs 10 x greater for preterm vs. full-term

– Currently, 2% deaths are in children

• Heavy emotional toll


Discussions: refocus


Discussions about end of life occur

. . . late, . . . too late, . . . or not at all.

How to address

• Recognize the issue on your human capital

• Determine the impact on your workforce

• Provide appropriate services

– Encourage financial planning

– Encourage wills

– Encourage Advance Directives

– EAP and counseling services

• Review and revise policies as needed

– Bereavement policies

– Long-term care policies


Resources


• Caring Connections — http://caringinfo.org/employer

• National Business Group on Health — www.businessgrouphealth.org

• Coalition to Transform Advanced Care — http://advancedcarecoalition.org/

• Best-practice care delivery models

• Empowering the public

• Educating health professionals

• Creating policy change

• Publications

• End of Life: A Workplace Issue. Health Affairs, 29, no.1 (2010): 141-146.

• MetLife Mature Markets Institute — http://www.metlife.com/assets/cao/mmi/publications/studies/2010/ mmi-working-caregivers-employers-health-care-costs.pdf

• The Caregiver Quandary — http://www.slideshare.net/pitneybowes/the-caregiverquandry-pitneyboweswhitepaper

Brent Pawlecki, MD, [email protected]

www.theconversationproject.orgwww.theconversationproject.org

Empowering Employers as Part of the Solution

ModeratorBrent Pawlecki, The Goodyear Tire and Rubber Company

PanelistsAnn Richardson Berkey, McKesson Corp.

Neil Trautwein, National Retail FederationJack Watters, Pfizer

Pam Kalen, National Business Group on HealthKathy Brandt, National Hospice Palliative Care Organization

Breakout SessionsPublic Engagement – Board Room

Professional Education – Lecture RoomClinical Models – NAS 125

Employer Solutions – NAS 120 Interfaith and Diversity – Members Room

This presentation was funded by the members of the National Business Group on Health and is for their exclusive use. To protect the proprietary and confidential information included in this material, it can only be shared, in either print or electronic formats, within and among member companies. All other uses require permission from the Business Group. 2010 National Business Group on Health.

Impact of Advanced IllnessOn the Workplace

What Employers Need to Know

Pam KalenNational Business Group on

Health151

Why Employers Care

152

• End-of-life issues, such as caregiving, serious illness, bereavement and advance care planning, can have a far reaching effect on both employees and the workplace as a whole.

• Family caregivers provide 80% of U.S. long-term care services

• The total estimated cost to employers for all full-time, employed caregivers is $33.6 billion.

Costs to Employers

153

•U.S. businesses lose $17.1 to $33.6 billion per year inproductivity for full-time employees with caregivingresponsibilities.

•The annual cost of grief in the workplacefor death of a loved one is estimated to be$37.5 billion.7

•An 8% differential in increased health care costs existsbetween caregiver and non-caregiver employees.

Beginning the Process

• Identify key stakeholders and obtain buy-in.

• Perform employee needs assessment through workgroups and employee satisfaction surveys

• Include questions in your work-life questionnaire about advanced illness and palliative care, as well as planning for the future.

• As part of your health assessment or work-life questionnaire, ask employees if they are in a caregiving role

Benefits and Communications

• Review coverage under both medical and prescription plans to determine if there are any gaps in palliative and hospice care.

• Assess support programs, gap analysis and resources for advanced illness planning that might be available through EAP or other vendors.

• Determine the communications needs for both managers and employees and develop an appropriate plan for them and other key audiences.

Advance Directives

• Share information with employees on the importance of having an advance directive.

• Require vendors that are involved in care case management and resource and referral programs to ask employees and their dependents if they have an advance directive.

• Include in key communications the legal resources available for drafting advance directives and estate planning documents.

www.businessgrouphealth.org

End-of-Life Issues in the Workplace

Kathy Brandt, [email protected]

End-of-life Issues in the WorkplaceEnd-of-life Issues in the Workplace

• CaregivingCaregiving• Serious illnessSerious illness• GriefGrief• Advance care planningAdvance care planning

NHPCONHPCO’’s Employers Guides Employers Guide

• AssessmentAssessment• Work-life ProgramsWork-life Programs• Benefits and PoliciesBenefits and Policies• Communication ResourcesCommunication Resources• Learning ModulesLearning Modules• Brochures for managers and Brochures for managers and

employeesemployees

Assessment Strategies & ToolsAssessment Strategies & Tools

• Assess workplace programs & policies Assess workplace programs & policies • CultureCulture• CommunicationCommunication• TrainingTraining• EvaluationEvaluation• Programs/resourcesPrograms/resources

• Assess the needs of supervisorsAssess the needs of supervisors• Employee needs assessmentEmployee needs assessment

Work-Life ProgramsWork-Life Programs

• Employer-sponsored initiativesEmployer-sponsored initiatives• Goals :Goals :

• Increase employees access to informationIncrease employees access to information• Enhance ability of supervisors to support Enhance ability of supervisors to support

employeesemployees• Increase opportunities for peer supportIncrease opportunities for peer support• Improve morale, retention, productivityImprove morale, retention, productivity

ProgramsPrograms

• Information and referral programsInformation and referral programs• Caregiver supportCaregiver support• Lunch-and-learnsLunch-and-learns• Employee health fairsEmployee health fairs• Support for employees coping with Support for employees coping with

griefgrief

Benefits and PoliciesBenefits and Policies

Goals:Goals:• Improve companyImprove company’’s competitive s competitive

advantage in recruitingadvantage in recruiting• Improve employee moraleImprove employee morale• Increase retention and productivityIncrease retention and productivity


Assess, modify and/or add:Assess, modify and/or add:• Funeral leaveFuneral leave• Bereavement leave Bereavement leave • Sick leave Sick leave • Leave of absenceLeave of absence• Alternative work schedulesAlternative work schedules


• Action StepsAction Steps• Make sure that employees know about Make sure that employees know about

benefits and policiesbenefits and policies• Provide ongoing training for Provide ongoing training for

supervisorssupervisors• Involve staff in the design of benefits Involve staff in the design of benefits

and policiesand policies• Respect the privacy and confidentiality Respect the privacy and confidentiality

of employeesof employees

Communication ResourcesCommunication Resources

• Templates for posters & flyersTemplates for posters & flyers• Newsletter articlesNewsletter articles• PowerPoint presentation for PowerPoint presentation for

leadershipleadership

Learning ModulesLearning Modules

• End-of-life Issues in the End-of-life Issues in the Workplace Workplace

• Supporting Working Caregivers Supporting Working Caregivers

www.caringinfo.org/employer

Outcomes from Pilot Outcomes from Pilot

• The assessment process uncovered a The assessment process uncovered a greater need than previously thoughtgreater need than previously thought

• Managers more aware of employee Managers more aware of employee needsneeds

• Brochures rated as very usefulBrochures rated as very useful• Presentations from local hospice were Presentations from local hospice were

extremely informativeextremely informative• Support after sudden death Support after sudden death ““invaluableinvaluable””

Tools You Can UseTools You Can Use

• Caring Connections - Caring Connections - www.caringinfo.orgwww.caringinfo.org• EmployerEmployer’’s Guides Guide• Educational brochuresEducational brochures• Outreach GuideOutreach Guide

• National Healthcare Decisions Day – National Healthcare Decisions Day – www.nationalhealthcaredecisionsday.org

http://www.nationalhealthcaredecisionsday.org/



Closing Plenary

Jennie Chin Hansen, CEO, American Geriatrics Society

Summit GoalsA greater understanding of the issues and challenges, their causes and potential solutions among American society and leadership: health care consumers; faith-based organizations; clinicians; health insurance plans; employers; policy makers; and public advocates, including those representing culturally diverse communities. A shared sense of mission and action steps needed to reform and improve advanced illness care in America, including: system innovations; public engagement; policy changes; and health professional education and support. The emphasis will be on quality care and patient satisfaction, and an agenda that addresses COMMUNITIES, individuals, systems, and policy.

Cost and Benefits

Build on new and existing data from innovative advanced care management models that improve patient/family quality of life, lower costs, and affect other key metrics, to identify ways to improve data and evidence on supporting greater benefit/value through health care reform.

Public EngagementHighlight best-practices/innovations in public engagement including: receptive audiences, effective messages, metrics, and dissemination strategies.

Create awareness of the need for programmatic coordination among public engagement initiatives -- specifically, related to developing and coordinating a common language about the terms to use and shared messaging.

Professional EducationBuild consensus around the competencies clinicians need to deliver high quality advanced illness care. Raise awareness of existing innovative tools and solutions in clinician support and training. Empower champions within health care systems to advocate for curricula transformation.

Clinical ModelsIdentify clinical best practices in caring for people with advanced illness with the potential to effectively serve the advanced illness population across the country. Achieve consensus on common process and outcomes measures that can be used to assess the clinical effectiveness and patient and family satisfaction with treatment of advanced illness. Agree on the structure of a national pilot that can be used to scale and replicate effective innovations in advanced illness care and to create an evidence base that is critical to advocacy for payment reform.

Empowering EmployersThink about ways in which your organization can take steps to increase its support of employee caregivers. This can include items that are top-down such as flexible leave time and geriatric care managers or bottom-up such as brown bag info sessions and support groups. Review the Employer Checklist and share with your colleagues. Take proactive steps to implement one or more of the recommendations.

Faith & DiversityImprove the quality of spiritual care across settings by reducing variations in the quality of care, particularly for traditionally under-served and marginalized populations. Have clergy and faith communities help their members become more health care literate and invite discussion and dialogue about how their faith, beliefs, and values inform their health care choices. Credential clinicians and other health care professionals caring for persons with advanced illness based on their demonstrated ability to provide compassionate, high quality, whole person centered care, and to attend to the physical, psycho-social, and spiritual domains of care.

Policy & AdvocacyIdentify policy barriers to fundamental system change leading to more person-centered, comprehensive, team-based approaches to caring for Americans with advanced illness and lay out a roadmap to reform with legislative and regulatory remedies to overcome those barriers Design a targeted public engagement and advocacy campaign using identified networks and working with messaging experts on communication to create a grassroots and grasstops movement for change

Policy & AdvocacyAction Steps from the Perspectives from the U.S. Senate: Achieving High-Quality Advanced Illness Care for Our Seniors Panel:

•Developing a Brand/Common Terminology•Supporting CMMI Innovation Challenge Awards/Pilots•Partnering with Faith Leaders

Stay Engaged With C-TACFor more information on joining C-TAC and participating in any of our workgroups please visit: www.thectac.org or email [email protected].

Keep up with C-TAC on Twitter at: @CTACorg

http://www.thectac.org/

mailto:[email protected]



Entertainment & Humor

2013 National Summit on Advanced Illness Care