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Leaders from across and outside the healthcare field gathered virtually for C-TAC’s second annual National Policy Forum this week to discuss how the policy landscape for serious illness care has shifted during the COVID-19 pandemic.

The event began with opening remarks from C-TAC Executive Director Jon Broyles, who reflected on our mission to ensure a high quality of life for 12 million people living with serious illness by 2030. He noted that the Policy Forum should open a dialogue that will allow us to create an ecosystem of community-based care that addresses the medical, social and spiritual needs of those with serious illness.

“The conversation starts today,” Broyles explained. “We need your help informing these public policies. We need your help advocating for these public policies.”

He was joined by Rev. Dr. Yvonne Delk, a C-TAC Board member who also serves as Minister of the United Church of Christ. Rev. Dr. Delk described the significance of the moment by emphasizing “the fierce urgency of now,” recalling a quote from Rev. Dr. Martin Luther King, Jr. when he spoke during the March on Washington in 1963.

The first panel session focused on the healthcare gaps exposed by the COVID-19 pandemic, with experts from Altarum, ResolutionCare and naviHealth offering recommendations for policy interventions that can address the needs of those with serious illness. Key areas of focus included the ability of those with serious illness and their families to afford non-medical necessities such as food and housing. Speakers also discussed the expanding role of telehealth during the COVID-19 pandemic.

Kristofer Smith, MD, President of nH house Calls at naviHealth, said that telehealth has an important role to play in serious illness care but that it should not replace in-person visits.

“Our best available evidence around care models for advanced illness patients shows there is a face-to-face element that enables trust-building,” said Dr. Smith. “On the other side of that, you can probably use video visits to improve efficiency once that relationship has been established.”

Access to essential services like advance care planning (ACP) is a key priority for C-TAC, as was outlined in a session featuring our policy team that offered updates on our latest policy initiatives. C-TAC is making several recommendations to ensure that everyone can define their goals of care, including waiving patient cost-sharing for ACP services and broadening the pool of providers who can be reimbursed under Medicare for leading ACP conversations.

Additionally, C-TAC is advocating for innovative policies that fortify the serious illness care workforce. This involves supporting training for hospice and palliative care providers, but also tapping into the wealth of talent and expertise of others involved in care, including social workers and community health workers.

C-TAC’s third area of focus is advocating for policies and resources that expand access to non-medical social and community supports that have a major impact on quality of life for those living with serious illness. C-TAC is working to advance these priorities with the goal of ensuring that they benefit marginalized communities who have suffered as a result of healthcare inequities.

Barriers to ACP services were investigated further during a session that featured leading voices from across the field. One of the hurdles covered during this discussion was the need to widen access to remote ACP services, including audio-only telephone calls.

“The use of telemedicine, particularly being able to have a face-to-face visit either through your smartphone or audio is a wonderful advantage,” said Marisette Hasan, President and CEO of The Carolinas Center. “I love seeing that is a policy change that C-TAC is promoting.”

Supporting the workforce that provides these services is also vital, and strategies for strengthening that workforce were the focus of a session that featured experts from the CSU Shiley Institute for Palliative Care, the Center to Advance Palliative Care (CAPC) and PHI. This session included an acknowledgment that the specialty palliative care workforce does not currently represent the diversity of the population it serves. CAPC Chief Strategy Officer Brynn Bowman cited the Resident Physician Shortage Reduction Act as a vehicle for quickly increasing the number of physicians of color entering the workforce.

Our final panel addressed the timely issue of racial disparities in care which have come into sharper focus during the COVID-19 pandemic. We were joined by NAACP Minneapolis President Leslie Redmond and Minnesota Council of Churches CEO Rev. Dr. Curtiss DeYoung, who co-authored an Op-ed in the Minneapolis Star Tribune that examined disparities in care during the spread of the coronavirus. During their question-and-answer session, Leslie Redmond said that people need to actively combat institutions and processes that marginalize communities of color.

During our keynote session, Andy Slavitt, who serves as Board Chair for United States of Care and was previously Acting Administrator of CMS, reinforced the need to challenge our conventional approaches to care and finding solutions that work for everyone.

“Ask yourself whether you want to go back to being comfortable with the world as we had it or if you’re willing to risk some discomfort and asking the tough questions to make changes,” Slavitt said.

The event concluded with closing remarks from C-TAC Co-Chair Bill Novelli, who reiterated the importance of connecting the seriously ill with medical and non-medical supports as part of a community-based approach. We will explore these topics further in our virtual National Summit on Advanced Illness Care, taking place from Oct. 27-30, 2020.

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