The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

Health care leaders gathered at Harvard Law School on April 26 to discuss opportunities to redesign care delivery for people with serious illness. These efforts are informed by the shift to value-based care, which has been championed by innovators in the advanced care movement.

The event was part of the Project for Advanced Care and Health Policy, a collaboration between the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Coalition to Transform Advanced Care (C-TAC).

Featured speakers for the event included Diane Meier, MD, Director of the Center to Advance Palliative Care and Tom Feeley, MD, Senior Fellow at Harvard Business School’s Institute for Strategy and Competitiveness. Drs. Meier and Feeley shared their insight on the Primary Cares Initiative, recently announced by the Centers for Medicare & Medicaid Services, and explored new approaches for supporting people with advanced illness and their loved ones.

During her remarks, Dr. Meier also underscored the value of palliative care and its ability to reduce avoidable spending and utilization in all settings while improving quality of life and symptom management. Specifically, a 2017 study, published in the Journal of Palliative Medicine found that palliative care reduced total costs by over 35% when delivered in a home setting.

She noted that raising awareness of these benefits among those leading Accountable Care Organizations and patient-centered medical homes can be a challenge.

“It’s a mindset thing. It’s not data-driven,” Dr. Meier said. “The data are there and they are really compelling.”

Dr. Meier also responded to the newly-announced Primary Cares Initiative, which will incentivize providers to care for seriously ill patients through value-based payments. She acknowledged that details on the initiative are forthcoming but described it as a profound step forward.

“It’s the first time Medicare is acknowledging that the needs of seriously ill people are not being met by hospice or fee-for-service,” Dr. Meier said. “That’s huge.”

The second featured speaker, Dr. Feeley, focused on defining value for health care and how to address value-based care for people with advanced illness. The fundamental goal of care, Dr. Feeley explained, should be value for patients. Open communication between clinicians and patients is therefore critical to delivering high-quality care.

“What is really important are health outcomes that matter for patients,” Dr. Feeley said.

These outcomes, Dr. Feeley said, involve delivering care in the setting that is right for the patient. A 2018 Stanford University School of Medicine study found that 80% of Americans would prefer to die at home, if possible. Despite this preference, researchers reported that only 20% of Americans do so. Discrepancies like this stem from a health care system that has turned death into a medical event that the public does not understand, Dr. Feeley explained. Discussing goals of care with patients is an important part of mitigating this issue.

“If you ask people with advanced illness what they really want, they want to avoid hospitalization,” Dr. Feeley said.

He also emphasized the importance of funding public education initiatives that introduce advance care planning to a wider audience and prepare them to make decisions about their care. When advance directives have been filed, it is crucial that they be stored in a way that is easily accessible for clinicians providing care for those patients.

Above all, patients should remain at the center of their care. As Dr. Feeley explained, people with serious illness would like to play an active role in shaping their treatment.

“They want to participate in decision making,” said Dr. Feeley. “They want to be engaged and we want them to be engaged.” A video recording of this event will be available on the Petrie-Flom Center’s website.

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