Argentum 2016 Senior Living Executive Conference "Building a Movement -- To Change the Way America Treats Our Seriously Ill� Bill Novelli, Coalition to Transform Advanced Care (C-TAC) and Georgetown University
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Argentum "Roadmap" -- Executive Member Report • Aging U.S. population...creates unprecedented demand for the senior living industry in coming decades • Focus on workforce development, quality care, operational excellence, consumer choice and memory care • Collaborate with stakeholders to create initiatives, partnerships and goals so older Americans experience choice, quality service, innovation, independence, dignity and respect 2
Argentum and C-TAC: natural allies with common interests and opportunities to work together and make a real and positive difference in the aging of America
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“It did not occur to us to say: ‘You want to do major heart surgery on an 84-year old woman showing progressive signs of dementia? Are you nuts?’ The surgery absolutely repaired my mother’s heart…but before, while we were gently sinking, now we were in free fall. She was reduced to a terrified creature, losing language skills by the minute… Six weeks and something like $ 250,000 in hospital bills later (paid by Medicare…that is, by you) she was returned, a shadow being, to…her assisted living apartment.” - Michael Wolf in New York Magazine 4
"Here's a list of specialists he had to go to see regularly: head and neck surgeons (four in the same practice), medical oncologist, radiation oncologist, cardiologist, urologist, dermatologist, gastroenterologist, internist, two integrated medicine MDs, dentist, speech and swallowing therapist, and lymphoma therapist...and visits with a pulmonary surgeon, plastic surgeon, oral surgeon, ophthalmologist and palliative care specialist... with massive numbers of Rx drugs, ordered at two different pharmacies... We thought the integrated care MDs or the internal medicine MD would be more involved in the coordination, but even they were focused on their own individual contributions." -- A friend of Bill's describing her partner's illness 5
“I was the son of a mother and father who suffered from two…terrible diseases…cancer and Alzheimer’s. Having not discussed the ’what-ifs’ when my mom was of sound mind and body, we were guessing in trying to figure out the right thing to do.” - Johnny Isakson, U.S. Senator (R-GA)
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"We're good at addressing specific, individual problems...Give us a disease and we can do something about it....But give us...an elderly woman at risk of losing the life she enjoys--and we hardly know what to do and often only make matters worse.� - Atul Gawande, M.D.
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The Challenge of Advanced Illness Today The Issue: Rapidly aging population Health system ill-equipped to provide care for advanced illness
The Results: Greater risk for hospitalizations and unwanted treatment Conflicting medical advice Higher cost of care to families and the nation
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The Big Gap‌ What People Want
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What They Get
1. Be at home with family, friends
Recycled through the hospital
2. Have pain managed
Often unwanted, ineffective treatment
3. Have spiritual needs addressed
Often die in hospital, in pain and isolation
4. Avoid impoverishing families
At great cost to families and the nation.
What is Advanced Illness? Advanced Illness occurs when one or more conditions
become serious enough that general health and functioning decline, curative treatment begins to lose its effect, and quality of life increasingly becomes the focus of care -- a process that continues to the end of life.
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Care Continuum
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IOM report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.� September, 2014
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IOM Report Recommendations: • Improved delivery of comprehensive care • Improved clinician -- patient communication and advance care planning (person centered, shared decision making) • Increased professional education and development • Reformed policies and payment systems • Broad public education and engagement • Across the spectrum, the ability to measure performance 13
About C-TAC (Coalition to Transform Advanced Care) • National, non-partisan, non-profit coalition of 130+ organizations and leaders
• A catalyst and voice to support the growing movement across America to transform advanced illness/end-of-life care
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C-TAC’s Goal “All Americans with advanced illness, especially the sickest and most vulnerable, receive comprehensive, high-quality, person-and family-centered care that is consistent with their goals and values and honors their dignity.�
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C-TAC Strategy: Clinical Models • Identify and compare best practice clinical models from across U.S. • Engage health care systems, hospitals, physician groups and plans in adoption • Work on payment models (with AHIP) and publish recommendations 16
C-TAC Strategy: Community Action • Work with African American churches in pilots (Alameda County, Detroit, D.C.) with Kaiser Permanente and others • Expand to other sites, develop quality measures, disseminate findings • Combine clinical and community services 17
C-TAC Strategy: Policy/Advocacy • Pursue opportunities in Congress • Expand legislative task force and add regulatory task force • Inform, assist policy makers on advanced illness care • Secure CMMI agreement on Care Model demo 18
C-TAC Strategy: Measures of Success
• Engage in development of key measures: quality, access, timeliness, utilization and personcenteredness (with patient/family satisfaction)
• Work with NQF, NAM, others to establish accepted metrics 19
A Roadmap for Success
A field guide for action to achieve high-quality advanced illness care.
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“With the aging of the 78 million-strong baby boom generation, the time and the opportunity to do this is now. I hope that once you read A Roadmap for Success, you will be inspired to join the movement to transform advanced illness care in America.� - Victor, Dzau, M.D., President, National Academy of Medicine 21
Momentum for the Movement • • • • • •
Baby boomers aging NAM report: "Dying in America” Media attention (The Conversation Project) The (near) death of the death panels Atul Gawande best seller: "Being Mortal"* CMS regs: Medicare to pay for advance planning discussions with patients (strong public support) • C-TAC: catalyst and voice 22
Let’s Get This Right • Care quality improves, patient/family satisfaction increases, costs are contained • Argentum and member companies: work together with C-TAC to further common goals - policy advocacy, healthcare continuum, innovation, quality indicators, overall synergy • C-TAC Summit Sept. 20, 21: join us to plan and lead the movement After all, as Ellen Goodman (The Conversation Project) says: "The mortality rate in America is holding steady at 100 %. 23
"We all want to be the authors of our lives.� - Atul Gawande, M.D.
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