Health care equity and the racism found throughout the health care system is finally being openly acknowledged. At the core of our policy agenda is a commitment to advancing equity and dismantling systemic barriers to high quality serious illness care for traditionally underserved communities. C-TAC is developing a strategy focused on utilizing public policy levers (state and federal) to address inequity issues that impact those with serious illness and their loved ones. This includes:
Removing financial obstacles to quality serious illness care for low-income minority individuals, such as cost-sharing and deductibles.
Providing better access to preventive care and chronic care management in appropriate settings.
Increasing access to culturally and linguistically appropriate (CLAS) translation services.
Increasing diversity among care providers of all kinds, as well as investing in solidifying the community-based workforce, to include shoring up and better supporting community health workers, direct care aides, and personal care attendants.
Institutionalizing pathways that allow community members to play a larger role in designing and having decision-making influence over the health and social care infrastructure in their own geographies.
Through engagement with patients, families, consumer advocates, faith-based organizations, health systems, and others, we work to better understand what prevents access to that care and develop policies that address the specific needs of low-income and minority communities and the underlying social determinants of health. We believe in the unique needs of communities and the importance of local characteristics shaping solutions.
As we continue to face the COVID-19 pandemic, advance care planning is more important than ever. Our goal is Ensuring accessibility and use of advance care planning counseling, advance directives, and other advance care planning documents.
Improving Medicare’s coverage of advance care planning (ACP) services by eliminating financial barriers for these services, expanding the provider types that can get paid for these services under Medicare, and removing portability barriers to ensure people’s medical preferences are honored across state lines.
Standards for including ACP documents within an individual’s electronic medical record, and related research and evaluation of such standards.
Funding for on-line consumer and provider information and resources on ACP, as well as a culturally and linguistically appropriate national public and provider educational campaigns.
Focus on policies that improve gaps in ACP for minority communities, including advocating for a permanent expansion of the pandemic-related flexibility under Medicare to allow for reimbursement of phone-based, audio-only ACP services.
C-TAC encourages the development of new value-based care and payment models focused on those with serious illness, as well as the successful implementation of current promising models such as the Center for Medicare and Medicaid Innovation’s (CMMI) Primary Care First-Seriously Ill Population (SIP) Model. Supporting additional models that incorporate home-and community based serious illness management and nonmedical social supports and services, including palliative care, in a systematic and sustainable way is a critical step to increasing access to high-quality care for the most vulnerable.
Alternative Payment Models for serious illness care, including models that include key roles and defined support for family caregivers and home-and community-based palliative care providers
Requiring that all models providing care for individuals with serious illness include a quality measure of the use of advance care planning
Efforts to encourage CMMI to implement models that directly fund providers of non-medical social services that have an impact on health outcomes and spending
Requiring providers participating in CMMI demonstrations to explicitly report on the impact their efforts have on reducing health disparities, with an eventual shift to linking progress on this reduction to payment
Ensuring that new value-based payment and care delivery models include publicly reportable quality metrics specifically relevant to the serious illness population and adopted across Medicare, Medicaid, and private payer programs
Assessment and risk adjustment payment that accounts for the social determinant of health (SDOH) characteristics of patients
Collecting and disaggregating data to track and address social determinants of health, disparities in COVID-19 related testing, hospitalization, death, and recovery among different racial and ethnic groups
Flexibility in providing care, treatment, training, and assessment through technology, including expansion of broadband, use of telehealth in serious illness care programs, including fair reimbursement for telephonic/virtual care coordination across hospital, post-acute care, outpatient, and home settings, particularly in rural and underserved areas. We encourage the permanent removal of the geographic and originating site requirements for Medicare telehealth services that were waived as part of the COVID-19 response
Expanding the CAHPS survey and other measurement tools to incorporate questions relevant to people living with serious illness and their families.
We must bridge the traditionally siloed fields of medical care and social services by developing and advocating for new policy, flexible delivery and payment approaches, and programmatic channels that will integrate aging and disability network services into models of care serving the serious illness population.
Funding for the nation’s Area Agencies on Aging (AAAs) and others in the Aging Network to develop programmatic solutions to strengthen their ability to deliver community-based care and support to those living with serious illness and their families.
Expanding Medicare Advantage (MA) supplemental benefit flexibility and funding sources to support more investment from MA organizations in nonmedical social and functional service delivery for seriously ill members.
Full implementation of the Older Americans Act provisions directing the Administration on Aging to disseminate and collect feedback on its Principles for Person-directed Services and Supports during Serious Illness.
New funding opportunities to provide long-term supports and services for those with serious illness in minority communities.
Data collection and program evaluation for quality improvement in all programs
Increased funding for the Racial and Ethnic Approaches to Community Health (REACH), the only CDC program that funds communities working to reduce racial and ethnic health disparities.
Increased funding for State Health Insurance Programs (SHIP) to help seriously ill people and their family caregivers navigate the financial challenges associated with living with a life-limiting condition.
Ensuring visitation rights to the loved ones of individuals with serious illness in long-term care facilities and providing the necessary personal protective equipment (PPE) and supports for safe visits.
➢ Increased funding for the Long-Term Care Ombudsman Program authorized under the Older Americans Act and Elder Justice Act
With an aging population and a growing demand for serious illness care, it is essential that we strengthen the workforce on the frontlines.
Strengthening and expanding the workforce to better care for people with serious illness through programs for career development in primary, palliative, and hospice care and geriatrics and to train the next generation of clinicians, the direct care workforce, community health workers, and others. This includes increased funding for programs such as the Geriatric Workforce Enhancement Program (GWEP), the Geriatrics Academic Career Award Program (GACA), and the Community Health Worker Health Disparities Initiative
Policies that will enhance continuing education to increase the capabilities of the workforce to care for those with serious illness, including Administration support for the passage of the Palliative Care and Hospice Education and Training Act
Grants to medical schools and teaching hospitals for career development awards, workforce development and fellowships for palliative care and hospice doctors, nurses, social workers, and others
Inclusion of palliative care medicine as an eligible primary care service in the National Health Service Corps, as called for in the Provider Training in Palliative Care Act
Use of advanced practice nurses and physician assistants to provide initial certification of patients for hospice care
Policies for community-based palliative care that require it be delivered by trained/certified professionals
Training on serious illness in medical and health education schools, and development of new curricula on advance care planning and end-of-life care for continuing education, as called for in the Compassionate Care Act
Paid leave policies, especially for essential and direct care workers and a living wage and career development for the direct and personal care workforce.
C-TAC is committed to supporting the family caregivers of those living with serious illness. Many families caring for someone with serious illness struggle with significant financial, emotional, and health burdens due to their caregiving responsibilities.
A comprehensive suite of benefits and resources that reduce burdens on family caregivers and support the care they provide, including a caregiver tax credit to help with expenses, and programs to assist low-income minority caregivers
Policies that recognize family caregivers as key members of the care team, and that support all of the dimensions of their caregiving experience
Increased funding for respite care and adult day care services for temporary relief from the work and stress of being a family caregiver
Recommendations developed by the RAISE Family Caregiver Advisory Council, which is overseen by the Administration for Community Living (ACL)
Payment flexibility to support caregivers, including scaling policies that allow for direct payment to family caregivers in exchange for their efforts to support sick loved ones