strategic opportunities in advanced illness management, palliative care and hospice
TRANSCRIPT
Kathy Brandt, MS
Principal, the KB Group
Paul Malley, MA
President, Aging with Dignity
The American Society on Aging
Aging in America 2015
Describe advanced illness management, palliative care and hospice within the context of the aging network.
Identify key trends that are changing the fields of advanced illness management, palliative care and hospice.
Implement strategies to partner with or provide services to advanced illness management, palliative care and/or hospice organizations.
Hospice
Palliative care
Advanced illness management
Life-limiting
illness /condition
Physicians certify
less than 6 months
Started in US in 1970s
Volunteers
Medicare Benefit
Expanding access
Pre-hospice
Hospice
Disease Modifying Therapy
Intent: Restorative, curative
Palliative Care
Intent: Symptom relief, comfort
Diagnosis
Adapted from WHO
Palliative Care
Built upon early US hospice work
SUPPORT Study – mid-90s
RWJF (and other) funding
CAPC – largely hospital-based
“Pre-hospice” palliative care
The Health
ContinuumAdvanced Illness
Healthy / Reversible
Illness
Manageable, Early or
Stable Chronic Conditions
Serious, Progressive Conditions
that Limit Daily Activities
Hospice Eligible
Advanced Illness Management
Adapted from C-TAC
Palliative Care
Hospice
Links inpatient with home and
community-based services
Provides ongoing care at home
Focuses on patient activation & advance
care planning
Engages physicians
Model: Sutter AIM
Changing paradigm
More oversight
Consolidation
Schism
Providing “upstream” care in creative
ways
Legislative & public champions
Body of literature expanding
Moving beyond hospital
More competition
Opportunities
Population health
Chronic care management
Oncology Care Model
Turf issues
ACA
Readmissions
Value-based purchasing
CMMI
Advance care planning
Aging Network
Hospice, Palliative
Care, AIM
The
People
We
Serve
Raise awareness and understanding
Help people identify community
resources
Build a community collaborative focused
on common issues
Good first step: Gets people thinking
about what good care looks like
Begins family discussions
Appropriate topic for the aging network,
healthcare providers, faith communities
Often becomes the “glue” that holds a
community collaborative together
“Alliance for Living and Dying Well”
Community collaborative: hospitals,
hospices, universities, places of worship,
senior centers, home healthcare
providers, employers
Outreach and speakers bureau in
English and Spanish
Provide resource material in all partner
locations
City and County (Shelby) partnership
Part of Healthy Shelby, local government
initiative on health and wellness
Support of Mayor, county leaders, faith
leaders
Resources provided at city senior
centers and nutrition sites
Competing health systems unite for this
effort
Community collaborative led by local
hospice and physician group
Providing information and resources to
large employers
Hosting community events, dinners by-
invitation to build partnerships
Using National Healthcare Decisions Day
(April 16) as a rallying day
Aiming for an event at Lambeau Field in
2016
New Jersey Health Care Quality Institute
Mayors Wellness Campaign
Beginning pilot project this April 16, with
city leaders announcing efforts to
provide advance care planning
resources
Caregiver education and support
Embedded experts
Professional education
What else??
What are your priorities?
What population(s) do we all serve?
What does the community need?
Advance care planning
Goals of care conversations
Patient/family education
Continuity of care
Care management
Care transitions
Telehealth
Staffing
NPs
After hours nurses
Homemaker
Volunteers
Referrals
Telehealth equipment
Aging with Dignity - http://www.agingwithdignity.org/
Coalition to Transform Advanced Illness -http://advancedcarecoalition.org/
CSU Institute for Palliative Care -http://csupalliativecare.org/
Patient Quality of Life Coalition -http://patientqualityoflife.org/
NHPCO – www.nhpco.org
National Healthcare Decisions Day - www.nhdd.org
Kathy Brandt, MS
Principal, the KB Group
http://the-kb-group.com/
Paul Malley, MA
President, Aging with Dignity
http://www.agingwithdignity.org/
Thank you!