The Blog to Transform Advanced Care
Advancing Care through Innovation, Observation and Collaboration.
This week, we hosted our virtual National Summit on Advanced Illness Care, where our field convened to address the most pressing issues around care for people with serious illness. Amid this unprecedented window of opportunity for progress created by COVID-19 pandemic-related political shifts, this year’s summit was especially timely. We called on our movement to meet this moment and waived registration fees to ensure that all were able to engage with the impactful conversations unfolding.
The summit featured panels of dynamic speakers, covering a host of topics including advance care planning, health equity, and Medicaid innovation. Preceded by special pre-summit sessions on Monday, the two-day summit produced key takeaways for policymakers and stakeholders regarding how to build a health care system that works for all people living with serious illness. Keep reading for a recap of key sessions and visit the summit venue website to view content on-demand until January 31, 2022.
Addressing Equity in Care Models
This summit roundtable discussion featured speakers from influential organizations and agencies, including CMMI. The roundtable of experts addressed C-TAC’s “Core Principles” for care models and the case for addressing equity by supporting community-based models and the pathway to lasting success. Various components of care model implementation were covered:
- It is essential to consider equity in enrollment regulations. Mandatory vs voluntary models have ramifications for under-resourced communities and providers that must be explored.
- Measurements should be patient-centered and reduce administrative burden on model providers/participants.
- Payment needs to be flexible to meet the unique needs of the individual rather than programs for the “average” person.
- Payment should pay for needed services, not referrals.
“Referrals don’t change health outcomes, services do.”
– CMMI Representative
- There is a need to expand Value-Based Payment (VBP) arrangements into social services beyond referrals. Many VBP programs stop at promoting screening and referrals only.
- Care Coordination
- Since quality, coordinated care requires a range of skills and services, it is best delivered by a team of partner organizations.
- An effective method for coordinating care is to have a hub where all necessary information on available local services is housed. Navigators can access the hub for help with info on needed services for patients.
- Caring for the whole person means cutting through silos and boxes and coordinating services and payment beyond traditional medical care.
- Community knowledge/expertise/wisdom
- It is essential to recognize and leverage community knowledge, expertise, and wisdom in model development and implementation.
- Process to Effect Change
- It is essential to focus on legislative changes to allow federal and state agencies more room to offer and pay for non-clinical services.
- We can promote longer models to let participants benefit from expertise gained along the way and allow for revision and improvement.
The Intersection of ACP Policy and Practice
This roundtable discussion featured ACP experts and strengthened the case for continued change: that advance care planning should be integrated into every CMS program that touches the lives of the person with serious illness and their family. Key policy implications of ACP were addressed:
- ACP Reshapes Care Planning Conversations
- There has been an evolution in thinking and evidence for ACP. We are now preparing people for future decision making, as opposed to making plans for a specific situation.
- This is a process rather than a one-time conversation or single document.
- ACP Practice Guidelines and Standards
- Our field can develop practice guidelines and standards for ACP.
- Quality measures beyond whether a conversation occurred, such as patient-reported outcomes can improve ACP implementation.
- Payment for ACP Services
- VBP arrangements where organizations get credit for doing ACP rather than a specific ACP payment can simplify the process.
State Medicaid Innovation for Those Most in Need
Across the country states are taking action to develop new and standardized models of care that support people with serious illness and their families and improve health equity. This special roundtable discussion explored the case for Federal policy change and experts shared insights and guidance based on what’s unfolding in Hawai’i and other states:
- There is promising work going on at the state level to develop ways to deliver care for those with serious illness. Multiple states either have Medicaid programs or are developing them.
- Guidance for state coalitions:
- Start with the highest need population and build from there.
- Focus on standardizing definitions and services within and across states.
- Know how a new palliative care benefit would interact with existing care Medicaid programs and how care for serious illness fits into the existing or planning continuum of services.
- Be aware of other pathways like waivers that a state may already be considering and align with such pathways if possible.
- Coalitions can form around a type of care, such as palliative care, or a population or type of illness.
- Identify provider capabilities and look for ways to help get them ready to provide the needed services
Communities Leading the Way: C-TAC’s National Agenda
Leaders from AARP, Humana, Cambia and others shared why C-TAC’s national policy agenda is critical to improve the lives of those with serious illness and those unpaid caregivers that support them. The roundtable discussed the importance of value-based payment models that incorporate community-based organizations to help eliminate health disparities and provided an in-depth overview of C-TAC’s agenda. To learn more about C-TAC’s policy agenda, visit our website here.
ACP Innovation and the Pandemic: A National Conversation
Hosted by Respecting Choices, this pre-summit session highlighted the importance of ACP as a critical area to focus policy making efforts. Panelists shared insights on how ACP evolved during the onset of the COVID-19 pandemic, including the successful implementation of virtual and creative witnessing/notarization methods.
When considering the future of ACP in a post-pandemic world, discussion addressed how state legislative changes may be required to allow more flexibility for future pandemics, disasters, and the needs of those living with serious illness. Panelists affirmed that care planning conversations are more important than documents, but challenges arise in promoting this as a process or policy effort. Additionally, the support for ACP continues to grow as new evidence from a NEJM article exhibiting ACP efforts that improved equity and showed lower utilization.
The Florida House Call Project: A Community-Based Model to Enhance HBPC Awareness and Access
Hosted by Home Centered Care Institute (HCCI), this pre-summit session shared insights gained from an innovative pilot program in Florida aimed at spreading awareness of home-centered care, communicating the benefits of Home-Based Palliative Care, and leading local training and in-service activities.
Panelists discussed the need to focus on mobility and function as important factors for those with serious illness, as they are not adequately reflected in current CMS policy.
Additionally, experts agreed that the overlap between home-based primary care and home health needs to be recognized and leveraged to improve health experiences.
In two days, the national summit served as the impetus for forthcoming change that will advance our field into a post-pandemic world where health care works for all people living with serious illness. To view summit content on-demand, visit the summit venue website here.