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C-TAC Releases Report on Policy Barriers to Advanced Illness Care Models

Americans are living longer than ever before but longer life also brings a greater prevalence of chronic illness. While the U.S. health care system handles acute medical issues quite well, it is poorly equipped to provide appropriate care for people with advanced illness. Such patients typically receive care that is uncoordinated and treatments they do not want or benefit from.

Seeking to address this, clinicians and payers have implemented a number of innovative models to deliver care that better reflects patients’ goals and values. The Coalition to Transform Advanced Care (C-TAC) developed a report to highlight innovative models designed to provide palliative care in a community setting to people with advanced illness. They represent a range of organizations and payment types and include a hospice that provides community-based palliative care on an fee-for-service (FFS) basis (Four Seasons), a risk-bearing multispecialty accountable care organization (ACO) practice (ProHEALTH), and a health plan (Aetna). The report also reviews the policy barriers such models face and outlines recommendations to address them.

The report’s key findings are:

  • Payment and Supporting Interdisciplinary Team Care – Medicare’s current FFS payment model does not cover the full range of medical, psychosocial, and spiritual supports people living with advanced illness need, nor all the members of an interdisciplinary team to deliver This discourages the full use of such teams to deliver needed care.
  • Upfront investment – Current payment models, even new ones such as ACOs, that enable groups of practitioners to coordinate care and share in any savings, typically do not allow for upfront funding for investment in program infrastructure. This makes launching new programs challenging, especially for smaller and rural health systems.
  • Rules for the provision of services – Medicare Conditions of Participation govern home health and hospice agencies but are outdated and siloed. This impedes the delivery of coordinated services to people at home and prevents the adoption of new innovations in home-based care.
  • Restrictive eligibility requirements for the Medicare Hospice Benefit – Current eligibility requirements for the Medicare Hospice Benefit force beneficiaries to forgo disease-directed care. This makes clinicians and patients reluctant to consider hospice until late in an illness, resulting in delayed or missed hospice admissions.

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