B-TAC

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Advancing Care through Innovation, Observation and Collaboration.

Lessons Learned: How to Implement a Serious Illness Program

In the Summer of 2017, the Hospice of Cincinnati and the TriHealth system in southwestern Ohio received a multi-year start up grant from local funder bi3 start a new home based palliative care service, PalliaCare Cincinnati.

In addition to the community based advance care planning program I designed and manage, I was asked to pull together this new program under a tight timeline.

Here’s what I learned:

  • It’s going to take time. I cannot overemphasize how much time and effort it takes to develop the infrastructure and staff needed to launch a new program in home based palliative care. Selecting the right people to be on the team was crucial to our early success.
  • Referral sources, patients and families need to be educated. In the first 9 months, PalliaCare had 325 incoming referrals. We purposely managed incoming referrals closely.121` are active patients, and 78 were discharged to hospice or died. The remaining 126 did not enter home based palliative care either because they did not meet defined clinical criteria, weren’t interested in the service, or were otherwise unable to be contacted.
  • Use the right framework…. and tape it to your office walls. This is optional, but I found it helpful. I used C-TAC’s Serious Illness Program Design and Implementation Framework, which has the detail I needed to navigate the many daunting details required to start a program. Broadly, the framework covers five pillars: the business model, definition of the population served, structure and services, outcomes measurement and implementation details.

Accountability for thoughtful program development, choosing the right team members and using the framework for guidance has contributed to early successes. Moving forward we’re working on change management, evaluation, community engagement and sustainability planning.

When I look at the big picture, I’m encouraged by C-TAC and AAHPM’s progress on the design and implementation of a new payment model, as well as the validation of such work by experts on the Physician Focused Technical Advisory Committee and the bipartisan support for change we’re seeing in Washington.

With payment reform on the horizon, I believe that many other program administrators will be asking “how to?” when it comes to implementing quality care programs. That’s why I’ll be at the Summit this year, where we’ll be tackling some challenging issues in implementation, from policy to culture change.

I hope to see you there!

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