The Blog to Transform Advanced Care
Advancing Care through Innovation, Observation and Collaboration.
In Arizona, a group of more than forty dynamic health-related organizations are leading the charge to improve the quality of care and outcomes for people with serious illness. Known as the Arizona Coalition to Transform Serious Illness Care, this state-based movement is led by, AZ Hospital and Healthcare Association, Discern Health, AZ End of Life Care Partnership, and C-TAC. The synergy of the Arizona Coalition advances key elements of C-TAC’s policy agenda, such as the implementation of care and payment models that incorporate home- and community-based medical and non-medical supports and services, including palliative care, in a systematic and sustainable way.
Most recently, the Arizona Coalition has engaged in research to inform the design of a home- and community-based palliative care (HCBP) and payment model. This initiative underscores state-level efforts to finance palliative care models that serve the holistic needs of patients living with serious illness. The need for models that provide medical and non-medical support and services for serious illness is a key driver of C-TAC’s policy agenda, and the Arizona Coalition’s leadership in advancing palliative care access is an example of the state-level action sparked by our coalition’s shared policy priorities. Field leaders in states like California, Illinois, and Hawai’i are either breaking ground in creating palliative care benefits or have already assisted with their implementation.
To support the care model design process, the Discern Health team, in partnership with the Arizona Coalition and TopSight Partners, conducted a survey to collect key information about existing palliative and serious illness programs in Arizona. This included their size, the kinds of patients they serve, the services they provide to patients and caregivers, and their strategy to financially sustain their operations.
The Arizona Coalition found that the responding organizations use a variety of criteria to see who is eligible to participate. Of programs delivering non-hospice palliative care services, most respondents identify potential participants with multiple chronic conditions (83%), severe medical conditions (79%), or people that need help performing daily activities (76%). These organizations also provide a diverse set of services to meet the healthcare and other needs of people living with serious illness. The most common are symptom and pain management (93%), care coordination (93%), and advance care planning (90%). Some programs offer transportation services (14%) and food delivery (7%).
When it comes to financing these services, most organizations utilize a fee-for-service payment model and/or bill a federal program, and many report being unable to receive reimbursement for specific services and features. However, 17% are already participating in an alternative or value-based payment model.
Partnering with community-based organizations (CBO) is an important aspect of care delivery for serious illness programs in the state. The Coalition’s research found that nearly 60% of responding programs delivering non-hospice palliative care services partner with a CBO to provide non-medical support and services. This aids providers in overcoming identified barriers to delivering palliative care, but barriers persist: 79% of organizations still struggle to effectively communicate the purpose of palliative care programs and 68% identified financing as a challenge.
The HCBP model will be informed by findings from the Arizona Coalition’s research and grounded in consensus guidelines, key lessons from existing models, stakeholder experiences, and local community resources in Arizona. The Arizona Coalition’s efforts to increase palliative care access in the state will undoubtedly inspire and inform additional state-level movements to implement care models that align with C-TAC’s policy agenda and guidance.
We have developed a set of core principles to ground the design of care and payment models, such as the Arizona HCBP model, that effectively serve the holistic needs of people living with serious illness. To receive updates on the release of these principles, state coalition progress, and C-TAC’s policy and advocacy work, subscribe to our newsletter here.