2013 National Summit on Advanced Illness Care
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On January 29 and 30, 2013 the Coalition to Transform Advanced Care (C-TAC) convened over 400 leaders -- from clinicians and policy makers to faith leaders and large employers -- to tackle one of ...

On January 29 and 30, 2013 the Coalition to Transform Advanced Care (C-TAC) convened over 400 leaders -- from clinicians and policy makers to faith leaders and large employers -- to tackle one of America’s greatest challenges, breaking though the cultural, health system and policy barriers so that seriously ill people receive the right care at the right time and place.

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  • The new affiliation will connect Henry Ford physicians, as on-call medical directors, to the 10 Southeast Michigan locations of MinuteClinic. In addition, MinuteClinic and Henry Ford will collaborate on educating patients and helping them to manage chronic diseases—including screenings and monitoring for diabetes, high blood pressure, and high cholestorol. Henry Ford physicians will accept patients who need a level of care that is not provided at MinuteClinic. Mark Kelley, M.D., executive vice president and chief medical officer of Henry Ford Health System, and CEO of the Henry Ford Medical Group. "We will be expanding our ability to provide appropriate care at the appropriate place. "Henry Ford doctors will consult with the on-site practitioners as needed. If people treated at a MinuteClinic do not have a primary care doctor for follow-up care, they will be given a list of local doctors, including Henry Ford physicians, from which to choose. “ MinuteClinic and Henry Ford will be developing a plan to provide clinical data integration to streamline communication for each person's care. With patient permission, MinuteClinic will share medical histories and visit summaries with other Henry Ford locations in Southeast Michigan. And MinuteClinic will continue its standard practice of sending visit summaries to the patient's primary care doctor, usually within 24 hours.
  • Eric
  • How many people work in an org that has work-life benefits or programs? Of those who raised hands – how many include grief, living with illness? How many employers educate staff re: ACP
  • Four EOL issues we are discussing are…. Three of them may impact some of your employees over time. ACP is something that you can promote to all employees. We ’ll talk about why as we review them. Employees with chronic health conditions put tremendous strain on employees Number of people with a chronic disease continues to increase Presenteeism costs are considered the largest costs of chronic health conditions – greater than direct medical costs (American Journal of Managed Care, 2006)
  • What work-life programs does your organization currently have related to work-life issues? These may seem like “nice to do, instead of need to do” but they can have a real payoff. Orgs of any size can do these.
  • I&R Explore local resources - AAA or united way, hospices, coalitions, etc have resources What will you offer? Printed materials, phone counselor, local org to manage the process (Fannie Mae) Publicize internally Evaluate – track inquiries, etc. Caregiver Directory of resources (print or online) Printed brochures Articles in employee newsletter re: caregiving Lunch and learns Support network – peer support, Lotsa Helping Hands, Share the Care Formal or informal caregiver support teams – volunteers providing support. Project Compassion www.project-compassion.org Lunch & Learns Based on assessment results Internal or external experts Advertise Evaluate Health fairs – efficient, table top displays, no cost Recruit diverse orgs Invite some re: advance care planning Grief If an employee dies, employee suffers a loss, employee seriously ill, critical or traumatic event Conduct meetings with the employees affected Provide education – supervisors and staff Offer support Be flexible Call local experts
  • Funeral/memorial – event We talked about grief (Bereavement) as a process. Grief is something people deal with for months. The grieving person can ’t “get over it” in 3-5 days. Funeral leave is what we call time after death for the “service” – minimum 3 days local, 5 days if travel for immediate family. Time off to attend service for colleague. Bereavement leave is available to employees when needed for up a year after death. Model policy has five days paid for immediate family – defined broadly. Basically it is a “trigger” for unscheduled leave. Employee can say “I need to take bereavement leave” by notifying supervisor . Small companies could adjust. It’s important to use language that differentiates between funeral/service and grief/bereavement. Sick leave – family-care and employee sick leave – need to specify in policies what sick leave can be used for – and communicate it Leave of absence – unpaid – typically 4 weeks or longer, case-by-case. Health insurance is offered but employee pays, accrual of benefits stops until employee returns Alternative work Job sharing Voluntarily reduced time Telecommuting Flextime – work hours change Compressed work week
  • If you change policies and don ’t tell anyone it doesn’t help. Communicate. Provide training annually on each of the EOL topics to assure supervisors know about policies and programs to support employees. Ask former or current caregivers or others who have experienced EOL issues to help create/modify or review policies Do not convey specific situations that employees face to other staff

2013 National Summit on Advanced Illness Care Presentation Transcript

  • 1. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation @CTACorg
  • 2. Stay Engaged throughout the Summit on Twitter @CTACorg #CTAC2013
  • 3. Welcome & Keynote AddressJudith A. Salerno, M.D., M.S., Institute of Medicine
  • 4. Master of Ceremonies Lisa Stark, ABC News
  • 5. Care Journey: Personal Reflections on Advanced Care Moderators Richard Address, Congregation M’Kor Shalom Tyrone Pitts, Progressive National Baptist Convention Panelists Amanda Bennett, Bloomberg News Nancy Brown, American Heart Association Suzanne Mintz, Caregiver Action Network Susan Reinhard, AARP Don Schumacher, National Hospice and Palliative Care Organization (NHPCO) Closing Remarks Brad Stuart, M.D., Sutter Care at Home
  • 6. Care JourneyPatient & Family Videos
  • 7. Care Journey: Personal Reflections on Advanced Care Moderators Richard Address, Congregation M’Kor Shalom Tyrone Pitts, Progressive National Baptist Convention Panelists Amanda Bennett, Bloomberg News Nancy Brown, American Heart Association Suzanne Mintz, Caregiver Action Network Susan Reinhard, AARP Don Schumacher, National Hospice and Palliative Care Organization (NHPCO) Closing Remarks Brad Stuart, M.D., Sutter Care at Home
  • 8. 65 Million Family CaregiversTypical Family Caregiver 1/3 are Higher Burden• 49 year old woman • Approx 40 hours of• Cares for a parent who care per week or more doesn’t live with her • Lives with Loved One• Provides approx 20 • Provides significant hours of care per week help both medical and• For about 5 years non medical • Can provide care for 10 years or more
  • 9. Caregivers Vs. Non-Caregivers• Spend $5,531 more on medical expenses, supplies, etc.• More likely to • go part-time • turn down promotions • give up employment• Over $300,000 in lost income, pensions, SSI• Higher incidence of depression and chronic disease
  • 10. Poverty, Race, Ethnicity Impact on Health • Lack of Access and Poorer Outcomes Compared to Whites · Those in poverty 80% · Latinos 60% · Blacks and AI/ANs 40%
  • 11. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation
  • 12. Assessing the Benefits and Costs of Transforming Care Moderator Mark McClellan, Brookings Institution Panelists Jeff Burnich, M.D., Sutter Medical Network Gail Hunt, National Alliance for Caregiving Randall S. Krakauer, M.D., Aetna Diane E. Meier, M.D., Center to Advance Palliative Care Dan Mendelson, Avalere Health
  • 13. Aetna Compassionate Care Trained, experienced case Impact managers provide: Case Management Education, support and resources for the member and their Favorable impact aligning family/caregivers Pain and symptom management – ensure patient goals with outcomes member has access to effective pain management and ongoing evaluation  82% of engaged decedents Facilitation of informed care decision choose hospice1 making – allowing the member/family to actively plan with the case manager and  82% reduction in acute their medical team what their wishes are inpatient days2 for continued care Review what they understand their  77% reduction in ER visits2 prognosis to be – Concerns about the path  86% reduction in ICU days2 ahead;  making decisions when/if they are unable  Improved quality of life  Planning how to spend their time as options become limited for Aetna members and  Review potential trade-offs that may arise over time their families  Address spiritual and cultural needs as appropriate 15
  • 14. Member Engagement: the Roots of Impact•Wife stated member passed away with Hospice. Much emotional support given tospouse. She talked about what a wonderful life they had together, their children, allof the peoples lives that he touched - they were married 49 years last Thursday andeach year he would give her a piece of jewelry. On Tuesday when she walked intohis room he had a gift and card laying on his chest, a beautiful ring that he had theirdaughter purchase. She was happy he gave it to her on Tuesday - on Thursday hewas not alert. She stated through his business he touched many peoples lives, andthey all somehow knew he was sick, and he has received many flowers, meals, fruit,cakes - she stated her lawn had become overgrown and the landscaper came andcleaned up the entire property, planted over 50 mums, placed cornstalks andpumpkins all around. She said she is so grateful for the outpouring of love. Alsostated that Hospice was wonderful, as well as everyone at the doctors office, andeveryone here at Aetna. {She tells all of her friends that "when you are part ofAetna, you have a lifeline.”} Encouraged her to call CM with any issues orconcerns. Closed to Case Management. Compassionate Care 16
  • 15. Barriers and Solutions• Inability to Identify cases • ID Algorithm, work with physicians to ID cases• Members with Advanced • Case manager initiates Illness are not engaged in outreach after verifying support in a timely manner case with physician• Insufficient communication between case managers • Case managers embedded and physicians and staff in medical offices• Hospice eligibility criteria • Liberalize Hospice entry represent unnecessary criteria – concurrent care barrier and 12 month course
  • 16. Using Patient Flow Data to Manage Risk, Enhance Patient Outcomes, and Improve Financial Performance / Dan Mendelson February 2013Avalere Health LLC | The intersection of business strategy and public policy
  • 17. Breaking the Readmission Cycle /Improving Care Coordination Across Continuum of Care Lack of communication, medication management, patient preparation, and follow-up care Sick Hospital Rehabilitation & Home Patient Nursing Facilities Health status deteriorates / Patient readmitted Success in coordinating care and allocating revenue will demand new affiliations and new capital investment strategies © Avalere Health LLC Page 19
  • 18. Patient Flow Patterns /Where Do Patients Go After Hospital Discharge? Medicare LTACH IRF SNF HHA Home Other 1% 3% 18% 9% 55% 14% Transition Emergency Department Readmissions (19%) (17%) What happens to a patient during the post-discharge period is very important / 19% of patients go to the emergency department, and an additional 17% are readmitted for care that could have been provided in less intensive settings, including homePAC: Post-Acute Care; LTACH: Long-Term Acute Care Hospital; IRF: Inpatient Rehabilitation Facility; SNF: Skilled Nursing Facility; ALF:Assisted Living Facility; HH: Home Health*The remaining 14% of Medicare patients discharged from hospitals either are discharged to other (e.g., another inpatient hospital) or die. © Avalere Health LLCSource: Avalere analysis of 2009 Medicare 100 Percent Standard Analytic File (SAF) claims data base from the Centers for Medicare and Page 20Medicaid Services (CMS). Beneficiaries may be counted more than once because they may have multiple hospital admissions during 2009.
  • 19. Readmissions /National Readmission Rates for Common Conditions Additional Avalere Conditions Diabetes Alzheimer’s Cancer Stroke Heart Disease Major Joint CKD Pneumonia* Endocrine Vent Care Infectious Disease Pulmonary Spinal Fusion Back Problems Neurology CMS HRRP Conditions MedPAC Select Conditions GI DisordersSource: Avalere Vantage CPS (Medicare SAFs 2010)The Avalere Pneumonia measure includes a broader set of pneumonia cases (pneumonia secondary to another © Avalere Health LLCcondition and pneumonia-like conditions) than the CMS PN measure Page 21
  • 20. Readmissions for AMI /Across Patients’ Next Site of Care Readmission rates differ significantly based on the next site of care— Risk adjustment is key for understanding differences in readmission ratesSource: Avalere Vantage CPS (Medicare SAFs 2010) © Avalere Health LLC Page 22
  • 21. Patient Flow Patterns /Henry Ford Hospital’s Current Local Market Referral Network Composite Rating 89% Henry Ford Hospital - Macomb-IRF St. John Home Care 20.7% 19.4% (HHA) 21.1% 2.0% CVS Caremark Henry Ford Hospital- MinuteClinic/ Macomb HFHS Clinical RA-RR = 20.0% Michigan Area Affiliation Agency on Aging 1B 23.9% (CMMI CCTP) 22.8% 33.2% 7.2% Shelby Nursing Center Medilodge of Sterling Hts. (SNF) (SNF)Source: Data powered by Vantage CPS; Medicare Nursing Home Compare (NH) and Medicare Home Health (HH) CompareNote: These readmission rates have not been risk-adjusted © Avalere Health LLC Represent Overall Star Rating based on NH Compare and HH Compare Page 23Composite Rating calculated based on 5 select HH Compare measures (i.e., patient education, falls risk, HF symptoms, pressure ulcers, wounds)
  • 22. Patient Flow Patterns /Henry Ford Hospital’s Recommended Local Market ReferralNetwork St. John Home Care (HHA) HFH-M- IRF 20.7% 19.4% Bay Nursing Inc. 21.1% 2.0% 16.8% (HHA) 7.0% Composite Rating 99.4% CVS Caremark MinuteClinic/ HFHS Clinical Henry Ford Hospital- Affiliation 3.8% Macomb RA-RR < 20.0% 14.6% 23.9% 7.2% 22.8% Henry Ford Cont. Care Ctr. (SNF) 33.2% Michigan Area Agency on Aging 1B (CMMI CCTP) Shelby Nursing Center (SNF) Medilodge of Sterling Hts. (SNF)Source: Data powered by Vantage CPS; Medicare Nursing Home Compare (NH) and Medicare Home Health (HH) CompareNote: These readmission rates have not been risk-adjusted © Avalere Health LLC Represent Overall Star Rating based on NH Compare and HH Compare Page 24Composite Rating calculated based on 5 select HH Compare measures (i.e., patient education, falls risk, HF symptoms, pressure ulcers, wounds)
  • 23. Patient Flow Analysis and Data Analytics /Focus in Transitional / FFS Environments Identify hospitals with high readmission rates Identify patients with high-risk of readmission Manage Risk or ED utilization Understanding performance on activities that affect payment Reduce readmissions Reduce ED utilization Enhance Patient Increase physician visits Outcomes Improve medication adherence Improve patient and caregiver satisfaction Reduce readmissions, ED visits, and other expensive inpatient care Improve Financial Substitute to higher quality/ cost-effective Performance PAC/ LTC settings Reduce per capita cost © Avalere Health LLC Page 25
  • 24. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation
  • 25. Having Your Own Say Jeff Thompson, MD Chief Executive Officer
  • 26. Aboutus... Delivery System •Integrated – Approximately 6,300 Total Employees – 768 providers employed / 484 medical staff – 51clinic locations – 325-bed Tertiary Medical Center •Western Campus of the University of Wisconsin Medical & Nursing School •Gundersen Lutheran Medical Foundation •Residency and Medical Education Programs •Research Program •Many affiliate organizations including EMS air and ground ambulance service, rural hospitals, nursing homes, hospice, etc. •$866.2 million Operating Budget •Physician-led organization •Strong Administrative/Medical partnership
  • 27. cialgaT Strategic Plan 2012-2016 Mission: We will distinguish ourselves Our Purpose is to bring health and well-being to our patients through excellence in patient care, education, and communities. research and improved health in the communities we serve. Vision: We will be a Health System of excellence, nationally recognized for improving the health and well-being of our patients, families, and their communities. Commitment: We will deliver high quality care because lives depend on it, service as though the patient were a loved one, and relentless improvement because our future depends on it. Values: integrity — Perform with honesty, responsibility and transparency. Excellence — Measure and achieve excellence in all aspects of delivering healthcare. Respect — Treat patients, families, and coworkers with dignity. Innovation — Embrace change and contribute new ideas. Compassion — Provide compassionate care to patients and families.Superior Outstanding Great Place Affordability GrowthQuality Patient Create a Culture Make our care more Achieve Growth that embraces a Affordable to our that supports ourand Safety Experience passion for caring patients, employers, mission and otherDemonstrate Create an and a spirit of andsuperior outstanding i-nrrtrniirsifti key strategies ou Liu LAU! Ly uusi.upQuality & Safety Experience improvementhrough the eyes for patients tof the patients & and familiescaregivers
  • 28. “We all die. A fundamental question is do wewant to have a say in how we live?” Jeff Thompson, MD Having Your Own Say Getting the Right Care When It Matters Most Gundersen Health System 4
  • 29. “In most respects, the patient were like thosefound in any ICU...yet these patients werecompletely different. ”“None had terminal disease, none battledmetastatic cancer, or had untreatable heartfailure or dementia. ” Atul Gawande, The New Yorker, August 2, 2010 5
  • 30. “But in La Crosse, the system means that peopleare far more likely to have talked about whatthey want and what they don ’t want before theyand their relatives find themselves in the throesof crisis and fear. When wishes aren ’t clear,families have also become much more receptiveto having the discussion. ” By Atul Gawande, The New Yorker, August 2, 2010 6
  • 31. “Discussion had brought La Crosse’s end-of-lifecosts down to just over half the nationalaverage. It was that simple – and thatcomplicated.” Atul Gawande, The New Yorker, August 2, 2010 7
  • 32. Patient and FamilyEvaluation Hospital Satisfaction 90th percentile th Clinic Satisfaction 90 percentile Gundersen Medicare 5 Star 75% Market Share Advantage Program
  • 33. Our Plan... •Advanced planning •Integrated delivery system •Available health record •Community collaboration •Not for profit mission 9
  • 34. Four Key Elements in Designingan Effective ACP Program #1 Systems Design #2 ACP Facilitation Skills Training #3Community Education and Engagement #4 Continuous Quality Improvement
  • 35. La Crosse Compared toNational Averages 100 90 80 70 60 50 40 La 30 Crosse 20 Nationall 10 y 0 % of severely or % of physicians Consistency terminally ill patient who between are aware of the known care plan with an advance advance care plan and care treatment providedJ Am Geriatr Soc 2010;58:1249– plan 111255.
  • 36. Australian Study Cont ’Outcomes when Subjects Died Intervention Control P value n (%) 29 (19) 27 (17) 0.75 Age median, (IQR) 85 (84-89) 84(81-87) 0.06 Sex, male n (%) 17 (59) 13 (48) 0.43 Patients completed ACP 25 (86) 0 (0) <0.001 Wishes known and followed 25 (86) 8 (30) <0.001 Wishes unknown 3 (10) 17 (63) <0.001 Effect on family 5 (2-5.5) 15 (5-21) <0.001 Impact of Event Score: median Effect on family 0 (0-1.5) 5 (0-9) <0.001 Hospital Depression Scale BMJ 2010;340:c1345
  • 37. Value of AdvancedCare Planning •Value of respecting or honoring a patient’s values and goals •Avoiding treatments the patient considers burdensome, thus avoiding unnecessary suffering and indignity •Being better able to provide care where the person would want it •Diminishing or eliminating the moral distress and its lasting effects experienced by family or medical staff members who must make healthcare decisions when they do not know what the patient would want 13
  • 38. How do we make integratedhealthcare really work? Preserving your health Heavy investment in primary care, disease management and rehabilitation Multiple layers of connectivity Electronic Health Record, Best Practice Protocols, Shared Education Program Electronic fetal monitoring sites, ER Telemedicine real-time hookup Focus on saving lives and preserving function •Extended TEC/Continuum of care •The critical care hospital of the future
  • 39. 15
  • 40. Our CareCoordination Plan •Nurses and Social Workers collaborating with multiple providers, and between patients and families to coordinate services and resources across continuum of health care to assist patients in reaching their optimal health. •The Care Coordination Program works with patients of all ages and is a service provided at no cost to patients. 16
  • 41. Care Coordination Program Out- We take care of Patient Managemen FFS patients the same t as those for whom we are at financial risk Average caseload is 1,200 patients
  • 42. lee"To heal the patient, heal the system." Brad Stuart, MD, CMO Sutter Care at Home GUNDERSEN HEALTH SYSIFEM
  • 43. Electronic Health Record Connectivity Pigagn Fans Wirohrli hndoporrionco • 14 Bleak Moor •Ai Fors s Arcade • Bilk Gales...111e „ 6-1 Rocneder Winona men 6.060 s Einnelaskasaiere TOrnah P Comp • Elroy MN 4 priusion 0 Lo CIV9St iardtsin H11111deeia. spnnp — Wonewac Greve Viroqua F, 61 Forgo Harmony ID WOO t Soldiers Grove, 0,9Cresco Richland Carder 1)Lone 4 Rork daleriar grilauktid Decorah Pausroda CO? Do-scabs. COsslan IA MadISOil S S Prairie Ora Chien Frro,lowo hoc Grego WI Wes! Union a toncorlor rifints* • GUNDERSEN HEALTH SYSTEM
  • 44. Having Your Say Owner Get .Edited by BERNARD J. HAMMES, PHD UNDERSEN HEALTH SYSTEM ting FIrit,WORD ax TOM HOUTSOUMPA.S..mou-rry-. a,MDME CPNTERFOLL ONO the GUNDERSEN HEALTH SYSIEM
  • 45. i"We all die. A fundamental question is do wewant to have a say in how we live?" Jeff Thompson, MD GUNDERS HEALTH EN SYSTEM
  • 46. Jeff Thompson, MDChief Executive Officerwww.gundluth.org
  • 47. Appendix
  • 48. National Recognition System-Wide Recognition •Top 100 Hospitals Five Year Performance Improvement Leader – Thomson Reuters •HealthGrades Distinguished Hospital Award for Clinical Excellence – Places Gundersen Lutheran in the top 5% of hospitals in the nation 6 times •Top 100 Hospital – Thomson Reuters •Top 100 Integrated Healthcare Network – Verispan •2009 Dartmouth/IHI/Brookings – Best value of 309 Medicare regions •2009 Commonwealth Fund Top Integrated Systems in U.S. •2010 Delta Group – Ranked # 1 of 118 academic centers •2011 Top 1% in HealthGrades outcomes
  • 49. Cost of Care in the Last Two Years of Life Hospital Days/Patient Total Cost of Care/Patient Hospital in Last 2 Years of Life During Last 2 Years of Life Gundersen Lutheran 13.5 $18,359 Marshfield/St. Josephs 20.6 $23,249 University of Wisconsin 19.7 $28,827 Cleveland Clinic 23.9 $31,252 Mayo Clinic 21.3 $31,816 UCLA 31.3 $58,557 University of Miami Hospital & Clinics 39.3 $63,821 New York University Medical Center 54.3 $65,660* Based on 2007 Dartmouth Atlas Study Methodology. The Dartmouth Atlas methodology examines hospital inpatient care for the lasttwo years of a Medicare patient ’s life.
  • 50. Stages of Advance Care Planning Over the Life Time of AdultsFirst Steps Next Steps Last StepsACP: Create POAHC and consider ACP: Determine what ACP: Establish specifi awhen a serious neurological injury goals of treatment should plan of care cwould change goals of treatment. be followed if expressed in medical complications result in orders using the POLST “bad” outcomes. paradigm.Healthy adults between ages 55 and 65. Adults with progressive, Adults whom it would not life-limiting illness, suffering be a surprise if they died in frequent complications the next 12 months.
  • 51. POLST Physician Order for Life Sustaining Treatment 27
  • 52. Lessons forHealthcare Systems •Almost all patients and families are willing to consider and talk about future medical decisions IF they see how this effort will improve their own treatment....we must be able to explain the benefits of the effort of having the conversation to the patient/family. •A standardized, patient-center, staged approach to these advance care planning conversations is crucial (rather than a legalistic approach). •An organized system of work flows, processes, and EMR is needed in all health care settings. The effort of ACP must be built into the routine of care and shown that it improves patient outcomes. 28
  • 53. Lessons forHealthcare Systems •To be successful with ACP requires the understanding, support, and involvement of the whole community and the other institutions that hold the community together: religious; business; government; schools; service groups. •In order to actually honor the preferences and goals of patients/families at the end of life, we need a delivery system that is more versatile that can be individualized to the patient ’s goals and health condition. 29
  • 54. Lessons forHealthcare Systems •The health organizations need to develop the “capacity” to assist patients with ACP and to honor plans before any public engagement. •Health organization should involve leaders from other organizations/institutions relatively early in this work and get these leaders on board. •Perhaps two years into the effort, the public at large need to be engaged about the value of this work for them knowing that all major institutions/leaders are supportive. 30
  • 55. Lessons forHealthcare Systems •This approach not only insulates health organizations from negative attacks, but can create a more positive image of health care. •The evidence shows that families who face complex, moral/medical decisions are better prepared with effective advance care planning and deal with grief in a healthier way (fewer complications). One might assume that this leads to not only positive feelings toward the health organization who provide end of life care, but also to fewer missed days at work. 31
  • 56. Definition: AdvanceDirective (AD) •A plan, made by a capable person or their surrogate, for future medical care regarding treatments or goals of care for a possible or probable event. •This plan could be expressed: •Orally or in writing •If written, it could be in strict accord with specific state statutes or simply a documentation of the plan, e.g., a physician’s note.
  • 57. Definition: AdvanceCare Planning (ACP)A process of planning for future medical decisions. This process, to be effective, needs to meet similar standards as the process of informed consent, i.e., the person planning needs to... – Understand selected possible future situations and choices; – Reason and reflect about what is best; and – Discuss these choices and plans with those who might need to carry out the plan
  • 58. Relationship ofACP to ADsADs are only as good as the process of planning: •If the person planning does not understand, reflect on, or discuss their choices/options adequately, the plan has a high probability of failure. •ADs success is directly tied to the quality of the planning process or ACP.
  • 59. Family Member... “I just want to thank you again for helping my Dad. The meeting was just what we needed. It would have been difficult to broach thosesubjects without you there to facilitate. I think his mind was put to ease by getting everything out in the open and it led to some very productive and loving conversations later in the day. ” 35
  • 60. ParticipatingOrganizations •AARP •Aetna •Amedisys •Center to Advance Palliative Care •Coalition to Transform Advanced Care (C-TAC) •Dartmouth Institute for Health Policy and Clinical Practice •Gundersen Health System •Honoring Choices Minnesota •National Palliative Care Research Center •Respecting Patient Choices, Australia •Sutter Health/Sutter Care at Home 36
  • 61. C TAC’s Four KeyAreas of Focus •Do what works: promote best practice care delivery (the models that work in clinical and community settings) to ensure high-quality, coordinated advanced illness care, across all settings; •Empower the public: help people to understand and make informed choices for themselves and their families and to call for change in care delivery and in policies; •Educate health professionals: to better serve patientsandfamilies/caregivers so people know their options, make informed choices, get the care they need, and avoid procedures they want don’t ; Create policy change: develop and advocate for federal and •state legislative, regulatory, judicial, and administrative initiatives, and for also private policies, to improve care for those with advanced illness. 37
  • 62. “La Crosse is Unique” Not so... Minneapolis-St. Paul, Medical Society, Allina, Health East, Park Nicollet Honoring Choices Minnesota 38
  • 63. HCM Engagement Inthe Community •To Demystify...taboo issues related to the death dying processes in the 21 st Century; and •To Inspire...Minnesotans to imagine becoming more involved in the end-of-life care decision- making process; •To Model...ways in which families can discuss embrace end-of-life care and planning; •To Support...families with an online “toolkit” of video and text tools; and •To Prepare...caregivers and families alike to certain that family choices are always make honored. 39
  • 64. Australian Experience Same Model Same Outcomes as U.S. GUNDERSEN HEALTH SYSTEM
  • 65. British MedicalJournal, March 2010 “Systematized model of advance care planning, following the principles established by Respecting Choices; could significantly improve ” •Patient and family satisfaction regarding care •Improve the knowledge of and respect for patients’ end-of-life wishes •Contribute to the quality of the end-of-life care •Reduce the incidence of clinically significant anxiety, depression and post-traumatic stress disorder in the surviving relatives of deceased patients 41
  • 66. Advanced Directives/POLST Care Coordination Palliative CareAdvanced Disease Coordination 42
  • 67. The Washington Context: PolicyOpportunities to Improve Advanced Illness Care Moderator Bruce Chernof, The SCAN Foundation Panelists Hanns Kuttner, The Hudson Institute Chris Jennings, Jennings Policy Strategies Senator Blanche Lincoln (D-AR), Alston & Bird Len Nichols, George Mason University
  • 68. Perspectives From the U.S. Senate: Achieving High Quality Advanced Illness Care for Our Seniors Moderator Susan Dentzer, Health Affairs   Panelists U.S. Senator Johnny Isakson (R-GA) U.S. Senator Ron Johnson (R-WI) U.S. Senator Mark Warner (D-VA) U.S. Senator Sheldon Whitehouse (D-RI)
  • 69. Closing RemarksLeonard D. Schaeffer, University of Southern California
  • 70. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation
  • 71. Keynote Address Speaker Kathy Greenlee, Assistant Secretary for Aging, and Administrator, Administrationfor Community Living, U.S. Department of Health and Human Services
  • 72. Empowering the Public to Make Informed Decisions and Plans Moderator Alexandra Drane, Eliza Corporation Opening Speaker Kent Wilson, M.D., Honoring Choices Minnesota Panelists Amy Berman, The John A. Hartford Foundation Lindsay Hunt, Institute for Healthcare Improvement/The Conversation Project Peg Chemberlin, National Council of Churches Terry Clark, UnitedHealth Bill Hanley, Twin Cities Public Television (TPT)
  • 73. “Honoring Choices MN” Twin Cities Medical Society & Twin Cities Public Television
  • 74. “Honoring Choices MN”What We Set Out to Do …•Change Societal Attitudes - Needed to be simple•Family Conversations–No Documents Required
  • 75. “Honoring Choices MN”What We Needed…•Broad Public Awareness: - 6 Full Docs, PSA’s, Web, Social Media, Newspapers•Human Story-Telling: Authenticity, Humor•Diversity: Faith, Culture, Identity•Direct Engagement: Listening Sessions, Ambassadors•Long-Term Commitment: Seven (7) Full Years
  • 76. “Honoring Choices MN”How We Approached It …•TCMS Laid Groundwork: with Medical Colleagues•Public TV: Asked to Design, Plan, Budget•Partnership: Shared Costs, Control, Copyright, Fund-raising•Plan, Revise, Go Again•Corporate “Lead”: CEO, Health Partners•Enlist other Media: TV, Radio, Newspapers, Social Media
  • 77. “Honoring Choices MN”Progress to Date …•Broadcasts (Docs & Spots): 700+•Web Usage: 22,000 Videos•Comm. Engagement: 38 Ambassadors, 100 Trainings•2011-12: Viewed as “Broadly Effective”•2013-17: Public TV will Continue to Broadcast
  • 78. “Honoring Choices MN” Twin Cities Medical Society & Twin Cities Public Television
  • 79. Empowering the Public toMake Informed Decisions and Plans Marios Story
  • 80. Catalyst, convener, coordinatorTwin Cities Medical Society Physician membership organization Representing over 5,000 physiciansOur Focus 2008-2010 --St. Paul/Minneapolis; 2.7 million 2010-present—statewide – 5 million
  • 81. MissionTo promote the benefits and implement processes and methods of advance care planning to the community at large
  • 82. Timeline +
  • 83. Impact1. 26 hospitals/health care systems2. 600 community based partners3. 45 volunteer Ambassadors trained; hundreds of presentations given4. Nearly 1,000 Facilitators trained to have discussions with individuals and families; 50 Instructors5. Documentaries air 90+ times; PSAs over 900 times6. 15,700 health care directives downloaded in the last 18 months.
  • 84. Lessons learnedCollaboration is essentialLocal oversight and governance is necessaryCommunity wants to be engaged in this workBroad based public engagement tactics are needed
  • 85. Contact InformationKent Wilson, MD Sue SchettleMedical Director Chief Executive OfficerHonoring Choices MN Twin Cities Medical Societytcms@metrodoctors.com sschettle@metrodoctors.com612-362-3704 612 -362-3799
  • 86. Working Together: Innovations in Inter-Professional Training ModeratorsDavid E. Longnecker, M.D., Association of American Medical Colleges Washington DC Cynda Rushton, PhD, RN, FAAN, Johns Hopkins University Panelists Patricia A. Grady, PhD, RN, FAAN, National Institute of Nursing Research Bud Hammes, Gundersen Health System Richard Payne, Duke Institute for Care at the End of Life Bob Wolf, Healthcare Chaplaincy
  • 87. Care Planning andAdvanced Illness Management Bernard “Bud” Hammes, PhD Director of Medical Humanities Gundersen Health System La Crosse, WI www.respectingchoices.org
  • 88. Fragmentation of CarePeople with advanced illness suffer greatly becauseour current system is fragmented:1.In space…from one setting to another we don’tshare a common plan/approach;2.Over time…we don’t keep in tune with individualschanging goals of care;3.By protocol…we provide treatment approachesthat are inflexible and at time either/or.Credit to Brad Stuart, MD.
  • 89. Correcting Fragmentation Requires:1. A care model that puts the ill person at the center of the care model; and2. A care team that can deliver this model through time and a cross settings of care in a way that meets the individual goals of each person.
  • 90. A new care model for those with advanced illness requires:• Care planning build into the routine of care• Care planning is achieved by well organized, effective conversations with individuals (and those close to them) and are updated over time• Care planning leads to clear plans• Care plans are always available to providers• Care plans are used thoughtfully when needed• The individual care plans can be met by a flexible care system where treatments provided are consistent with treatments desired
  • 91. Designing this new model requires1. We change our approach to the process of care planning…we need a staged approach;2. We need some fundamental redesign of the care system.
  • 92. Stages of Advance Care Planning Over the Life Time of AdultsFirst Steps Next Steps Last StepsACP: Create POAHC and consider when a ACP: Determine what goals ACP: Establish a specificserious, permanent neurological injury would of treatment should be plan of care expressed inchange goals of treatment. followed if complications medical orders using the result in “bad” outcomes. POLST paradigm. Healthy adults between ages 55 and 65 or Adults with progressive, Adults whom it would not be a anyone younger with a serious illness life-limiting illness, suffering surprise if they died in the next frequent complications 12 months.
  • 93. We also need to…• Redesign specific workflows, roles, and tools in the health system;• Train health professionals to conduct the care planning conversations at each stage and to work as a team;• Provide community engagement;• Improve these new systems through continuous performance improvement.
  • 94. For more information aboutthis approach go to:www.havingyourownsay.org.
  • 95. Integrating Spiritual Care to Transform Advanced CareBob Wolf – HealthCare Chaplaincy
  • 96. Definition - Spiritual Care Interventions, individual or communal, that facilitate the ability to express the integration of the body, mind, and spirit to achieve wholeness, health, and a sense of connection to self, others, and[/or] a higher power.American Nurses Association, & Health Ministries Association. (2005). Faith and community nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association.
  • 97. Existential Questions: WHY???• Every human being has a •WAS I BORN? spiritual dimension •MUST I DIE?• Every human being faces mortality •AM I HERE?• Mortality is challenging# © HealthCare Chaplaincy
  • 98. Faith: Letting Go – Moving On# © HealthCare Chaplaincy
  • 99. The NCP GuidelinesAddress Eight Domains ofCare:  Structure and processes  Physical aspects  Psychological and psychiatric aspects  Social aspects  Spiritual, religious, and existential aspects  Cultural aspects  Imminent death  Ethical and legal aspects
  • 100. Existential Equanimity• A state of being that accepts mortality withequanimity– Drives decisions about care of serious and life-limiting illness• Compatible with attempts to cure or to exclusively pursue palliation– Drives relationships with loved ones• Determinant of grief and bereavement course among family104 © HealthCare Chaplaincy
  • 101. Spiritual Support &CancerIn a large study of advanced cancer patients:  88% said religion was at least somewhat important  72% said their spiritual needs were minimally or not at all supported by the medical system  42% said their spiritual needs were minimally or not at all supported by their faith community.  Spiritual support was highly associated with QOL. (P=.0003) Balboni, et al. (2007). Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life. Journal of Clinical Oncology, 25(5), 555-560.
  • 102. Bill Gates:My Plan to FixThe WorldsBiggestProblems: From the fight against polio to fixing education, whats missing is often good measurement and a commitment to follow the data. Wall Street Journal – Saturday January 26th 2013106 © HealthCare Chaplaincy
  • 103. Spiritual Screening  Is religion/spirituality important to you as you cope with your illness?  How much strength/comfort do you get from your religion/spirituality right now?  Has there ever been a time when religion/spirituality was important to you? Fitchett, G and Risk, J. L. (2009). Screening for spiritual struggle. Journal of Pastoral Care and Counseling, 62 (1, 2), 1-11
  • 104. Spiritual HistoryF Do you have a spiritual belief? Faith? Do you have spiritual beliefs that help you cope with stress/what you are going through/ in hard times? What gives your life meaning?I Are these beliefs important to you? How do they influence you in how you care for yourself?C Are you part of a spiritual or religious community?A How would you like your healthcare provider to address these issues with you? © C.Puchalski
  • 105. Cicely Saunder’s impliedpostulate?The spiritual life provides an integrativefunction, working through attribution ofmeaning to connect our existence to thegrand narrative of existence. physical spiritual social psychological DAME CICELY SAUNDERS, OM, DBE, FRCP, FRCN FOUNDER AND PRESIDENT ST CHRISTOPHER’S HOSPICE 22 June 1918 - 14 July 2005
  • 106. Train Chaplains Spiritual Needs/Assessme TEAM Research literate Goals of Care Palliative nt Competencies Train Doctors and Nurses110 © HealthCare Chaplaincy
  • 107. What Gets in the Way: “I’m all for progress. It’s change I object to.” -Mark Twain
  • 108. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation
  • 109. Identifying and Replicating BestPractices in Clinical and Community Models Moderator Tom Smith, Johns Hopkins University Panelists Eric Anderson, Allina Health System Bill Borne, Amedisys Malene Davis, Hospice Innovations Group Dan Johnson, Kaiser Permanente
  • 110. LifeCourse“As I live well with serious illness, I am in charge. You listen to me, help me, guide me, honor me, and support me as a person.” 1. Ongoing, personal relationship with a non-clinical Care Guide 2. Interdisciplinary Team to address all domains of palliative care and coordinate across care settings and care partners 3. A complement to existing services and to the existing strengths and assets of the individual and caregivers Center for Healthcare 114 Research & Innovation
  • 111. Health Care @ Home Inflection Disruption Early Adoption Facilities The community-based delivery model is standardized. The interface differs Advanced Care according to the anchor Management in the community.
  • 112. Kaiser Permanente• Integrated health system, 8 regions + D.O.C.• Advanced illness care grounded in 3 RCTs• Strategies: INVEST, EDUCATE, and INTEGRATE • Access to specialty-trained palliative support across inpatient, home, clinic and NH settings • Systematic approaches to care planning (e.g., Respecting Choices) • Moving away from “referral-only” models; imbedding specialty support in high risk settings • Developing complex medical homes for most seriously ill
  • 113. The Innovations Group• What is the Innovations Group?• Additional examples of care coordination.• Hospice as a foundational model of community-based interdisciplinary care.• Advanced Illness---The Next Generation!
  • 114. The Innovations Group• Hope HealthCare Services • Capital Caring• Valley Hospice • The Elizabeth Hospice• Hospice of the Bluegrass • Covenant Hospice• Four Seasons • Hosparus• Hospice of Michigan • Suncoast Hospice• Chapters Health System • Midwest Palliative &• Hospice of Palm Beach Hospice CareCenter County • HopeHealth• Nathan Adelson Hospice • The Denver Hospice• Home & Hospice Care of • Hospice of Chattanooga Rhode Island • Hospice & Palliative Care of• Sutter Care at Home Western Colorado* The NHWG CEO participates as an invited member and an advisor
  • 115. The Innovations GroupHospices Leverage Core Competencies for Advanced Illness
  • 116. COMPREHENSIVE COORDINATED ADVANCED ILLNESS CARE H o s p i c e Interventions with Curative Capacity* Disease Modifying Interventions* Bereavement Palliative Interventions Consumer Education, “Coaching”, Empowerment Prognosis of Diagnosis of a Death foreseeable limited serious or chronic life expectancy or condition end-stage disease LTC = Long Term Care * until no longer meeting medically specified outcomes oAdapted from: Fine PG, Davis M. Fine PG, Davis M: 2006. Hospice: comprehensivecare at the end of life. Anesthesiol Clin;24(1):181-204.
  • 117. There are opportunities to improve our practice on hospice referrals
  • 118. The benefits are straightforward…better care,and people who use hospice for even one day live longer. Connor SR, et al. J Pain Symptom Manage. 2007 Mar;33(3):238-46.
  • 119. We miss opportunities to recognize hospice eligible patients, they are readmitted, and cost more. U of Iowa Hospitals. •688 in-hospital deaths •209 decedents had preceding admission •60% of decedents were eligible for hospice on the penultimate admission, based on NHPCO, National Hospice and Palliative Care Organization worksheets. -Only 14% had any discussion of hospice, despite being eligible; 14 of 17 enrolled, all from ONE serviceFreund K, et al. J Hosp Med. 2012 Mar;7(3):218-23. doi: 10.1002/jhm.975. Epub 2011 Nov 15.
  • 120. We miss opportunities to recognize hospice-eligible patients, they are readmitted, and cost more. Table: Comparison of Cost and Length of Stay Between Patients Enrolled and Not Enrolled in Hospice During a Terminal Hospital Admission Enrolled in hospice before last Not enrolled in hospice, all admission n = 7/14 diagnoses, n = 202/209 Cost Mean $4963 $52 219 Median $3690 $23 322 Standard $3250 $85 101 deviation Standard 4.47 25.05 deviation Palliative Care Consultation YES, $41,859 NO, $58,386 P<0.04 Freund K, et al. J Hosp Med. 2012 Mar;7(3):218-23. doi: 10.1002/jhm.975. Epub 2011 Nov 15. Weckmann MT, et al. Am J Hosp Palliat Care. 2012 Sep 5.
  • 121. People who use hospice are re-admitted less often, use less medical resources, and get better care.Table 2. Readmission Rate by Post-discharge Medical Service UsePost-discharge medical services Ratio of readmissions PercentHospice 11/240 4.6Home-based palliative care 5/60 8.3Home health 2/15 13.3Nursing facility 14/58 24.1Home no care 9/35 25.7Enguidanos S, Vesper E, Lorenz K. 30-Day Readmissions among Seriously Ill Older Adults. J PalliatMed. 2012 Dec;15(12):1356-61. doi: 10.1089/jpm.2012.0259. Epub 2012 Oct 9.Hospice saves Medicare $2309 per decedent, and the longer the hospiceLength of stay, the bigger the savings.Taylor DH Jr, Ostermann J, Van Houtven CH, Tulsky JA, Steinhauser K. What length of hospiceuse maximizes reduction in medical expenditures near death in the US Medicare program?Soc Sci Med. 2007 Oct;65(7):1466-78. Epub 2007 Jun 27.Better care, consistent with what people would choose.Smith TJ, Schnipper LJ. The American Society of Clinical Oncology program to improve end-of-life care. J Palliat Med. 1998 Fall;1(3):221-30.
  • 122. Hospice eligibility is straightforward –take out your smart phones and Ap this!• The SURPRISE QUESTION: “Would you be surprised if this person were to die in the next 6 months?”• Failure to thrive: BMI < 22, involuntary weight loss• CHF NYHA Class IV, EF < 20%• COPD: hypoxemia at rest, FEV1 < 30%• Dementia < 6 words• Liver disease: INR > 1.5, albumin < 2.5• Cancer – much easier. Salpeter et al. J Palliat Med. 2012 Feb;15(2):175-85. Prognoses < 6 months.
  • 123. Identifying hospice eligible patients makes a difference PC program
  • 124. How do we better integrate hospice into our care?• Have a “hospice information visit” when we think the person has 3-12 months to live.• Can’t hurt. OK to predict wrongly.• Can dramatically help • Makes us address difficult issues like “code status” • Informs family that the situation is serious and their loved one is dying (moves the angst upstream) • MOLST • Will, Living Will, DPMA, Life Review, Dignity therapySmith TJ, Longo DL. Talking with patients about dying. N Engl J Med. 2012 Oct25;367(17):1651-2. doi: 10.1056/NEJMe1211160.
  • 125. Barriers Opportunities•Provider Competition •Payer-Provider Collaboration•Challenges to System •Private Sector LeadershipIntegration •National Scale Pilots•Lack of Incentives •Common Metrics•New Training Needs •Comparative Data Analysis•Startup Costs •Payment Reform Advocacy•Reimbursement •Model Flexibility•Unique Local Issues
  • 126. Key Barriers and Solutions toInnovations in Advanced Illness Care& Management
  • 127. Questions
  • 128. Breakout Session Moderators Randall S. Krakauer, M.D., AetnaBrad Stuart, M.D., Sutter Care at Home NAS 125
  • 129. Empowering Employers as Part of the Solution Moderator Brent Pawlecki, The Goodyear Tire and Rubber Company Panelists Ann Richardson Berkey, McKesson Corp. Neil Trautwein, National Retail Federation Jack Watters, Pfizer Pam Kalen, National Business Group on Health Kathy Brandt, National Hospice Palliative Care Organization
  • 130. Advanced Illness and Caregiving:A workforce challengeBrent Pawlecki, MD, MMMChief Health OfficerThe Goodyear Tire & Rubber CompanyNational Summit on Advanced Illness CareJanuary 30, 2013
  • 131. The Goodyear Tire & Rubber Company• Goodyear is one of the worlds leading tire companies. ○ Goodyear is the No. 1 tire maker in North America and Latin America. ○ Goodyear is Europes second largest tire maker. ○ The world’s largest operator of commercial truck service and tire retreading centers. ○ Operates approximately 1,500 tire and auto service center outlets.• Founded in 1898 in Akron, Ohio.• 2011 annual sales of $22.8 billion. Consumer• Employs approximately 73,000 people around the world.• Operates 54 plants in 22 countries.• Blimps—our aerial ambassadors since 1925. ○ Goodyear operates three blimps in North America. 136
  • 132. Global Health Services • Building the Culture of Health – Health Benefits – Wellness Programs – Environment, Health and Safety – Emergency Preparedness Healthy, Engaged, Productive Employees 137
  • 133. Global Health Services Goal: Maximize the health and wellbeing of our associates, control benefits costs and improve productivity by:  Preventing illness.  When prevention is not possible, securing the right care at the right place at the right time.  When treatment is no longer possible, assuring that people have the tools available to support a dignified and respectful end of life. 好生活, 生活好选择 138
  • 134. Workforce Challenge—advanced illness Advanced Illness / End of Life • Americans living with advanced illness and their caregivers – Are not asked what care they want – Are not given the help to make good decisions about coordinated high quality care – Creates physical, emotional and financial hardships Coalition to Transform Advanced Care (C-TAC)
  • 135. Workforce Challenge—advanced illness Why it is an employer issue 1. Employees are caregivers – Demographic shifts • One in five will be 65 and older by 2030 • percentage of working age 18 - 64 declining – Caregiver duties • 7 to 10 million adults care for parents from distance • 25% of adults provide care to another adult • 64% of caregivers work full or part-time • 1 in 8 aged 40 – 60 care for both parent and child • roughly half were men
  • 136. Workforce Challenge—advanced illness Why it is an employer issue 1. Employees are caregivers – Productivity & financial impact (2006 MetLife) • $17.1 to 33.6 billion per year • Workday interruption at least one hour per week • 60% needed to attend to some crisis • 2.4 percent leave workforce entirely • Cost for full-time employed caregiver $2,110 • Uncaptured presenteeism costs
  • 137. Workforce Challenge—advanced illness Why it is an employer issue 1. Employees are caregivers – Unprepared • fewer than half of baby boomers have discussed their parents’ treatment wishes in the event of terminal illness • only 40% have discussed their parents’ will – Adverse health effects (2010 MetLife) • 8% increased health care expenses—13.4 billion/yr – Leaving workforce • Leave of absence (survey showed roughly 25% of caregivers considering and/or planning for it)
  • 138. Workforce Challenge—advanced illness Why it is an employer issue 2. Unexpected health crisis for employee or partner – 627,000 working age adults die each year – 2007, unintentional injuries caused 120,000 deaths and 26 million disabling injuries – Undocumented end of life issues • Treatment decision confusion • Emotional burden • Mounting medical and disability costs
  • 139. Workforce Challenge—advanced illness Why it is an employer issue 3. Childhood health issues – Parents / Grandparents as caregivers • Balance needs of other family members, household, jobs • Travel to specialty centers – Prematurity • One in eight in U.S., often with serious health conditions • First year medical costs 10 x greater for preterm vs. full-term – Currently, 2% deaths are in children • Heavy emotional toll
  • 140. Workforce Challenge—advanced illness Discussions: refocus Discussions about end of life occur . . . late, . . . too late, . . . or not at all.
  • 141. Workforce Challenge—advanced illness How to address • Recognize the issue on your human capital • Determine the impact on your workforce • Provide appropriate services – Encourage financial planning – Encourage wills – Encourage Advance Directives – EAP and counseling services • Review and revise policies as needed – Bereavement policies – Long-term care policies
  • 142. Workforce Challenge—advanced illness Resources • Caring Connections — http://caringinfo.org/employer • National Business Group on Health — www.businessgrouphealth.org • Coalition to Transform Advanced Care — http://advancedcarecoalition.org/ • Best-practice care delivery models • Empowering the public • Educating health professionals • Creating policy change • Publications • End of Life: A Workplace Issue. Health Affairs, 29, no.1 (2010): 141-146. • MetLife Mature Markets Institute — http://www.metlife.com/assets/cao/mmi/publications/studies/2010/ mmi-working-caregivers-employers-health-care-costs.pdf • The Caregiver Quandary — http://www.slideshare.net/pitneybowes/the-caregiverquandry- pitneyboweswhitepaper
  • 143. www.theconversationproject.orgBrent Pawlecki, MD, MMMbrent_pawlecki@goodyear.com
  • 144. Empowering Employers as Part of the Solution Moderator Brent Pawlecki, The Goodyear Tire and Rubber Company Panelists Ann Richardson Berkey, McKesson Corp. Neil Trautwein, National Retail Federation Jack Watters, Pfizer Pam Kalen, National Business Group on Health Kathy Brandt, National Hospice Palliative Care Organization
  • 145. Breakout Sessions Public Engagement – Board Room Professional Education – Lecture Room Clinical Models – NAS 125 Employer Solutions – NAS 120Interfaith and Diversity – Members Room
  • 146. Impact of Advanced Illness On the WorkplaceWhat Employers Need to Know Pam KalenNational Business Group on Health This presentation was funded by the members of the National Business Group on Health and is for their exclusive use. To protect the proprietary and confidential information included in this material, it can only be shared, in either print or electronic formats, within and among member companies. All other uses require permission from the Business Group. 2010 National Business Group on Health. 151
  • 147. Why Employers Care• End-of-life issues, such as caregiving, serious illness, bereavement and advance care planning, can have a far reaching effect on both employees and the workplace as a whole.• Family caregivers provide 80% of U.S. long-term care services• The total estimated cost to employers for all full-time, employed caregivers is $33.6 billion. 152
  • 148. Costs to Employers•U.S. businesses lose $17.1 to $33.6 billion per year in productivity for full-time employees with caregiving responsibilities.•The annual cost of grief in the workplace for death of a loved one is estimated to be $37.5 billion.7•An 8% differential in increased health care costs exists between caregiver and non-caregiver employees. 153
  • 149. Beginning the Process• Identify key stakeholders and obtain buy-in.• Perform employee needs assessment through workgroups and employee satisfaction surveys• Include questions in your work-life questionnaire about advanced illness and palliative care, as well as planning for the future.• As part of your health assessment or work-life questionnaire, ask employees if they are in a caregiving role
  • 150. Benefits and Communications• Review coverage under both medical and prescription plans to determine if there are any gaps in palliative and hospice care.• Assess support programs, gap analysis and resources for advanced illness planning that might be available through EAP or other vendors.• Determine the communications needs for both managers and employees and develop an appropriate plan for them and other key audiences.
  • 151. Advance Directives• Share information with employees on the importance of having an advance directive.• Require vendors that are involved in care case management and resource and referral programs to ask employees and their dependents if they have an advance directive.• Include in key communications the legal resources available for drafting advance directives and estate planning documents.
  • 152. www.businessgrouphealth.org
  • 153. End-of-Life Issues in the Workplace Kathy Brandt, MSkbrandt@nhpco.orgwww.caringinfo.org
  • 154. End-of-life Issues in the Workplace• Caregiving• Serious illness• Grief• Advance care planning
  • 155. NHPCO’s Employers Guide• Assessment• Work-life Programs• Benefits and Policies• Communication Resources• Learning Modules• Brochures for managers and employees
  • 156. Assessment Strategies & Tools• Assess workplace programs & policies • Culture • Communication • Training • Evaluation • Programs/resources• Assess the needs of supervisors• Employee needs assessment
  • 157. Work-Life Programs• Employer-sponsored initiatives• Goals : • Increase employees access to information • Enhance ability of supervisors to support employees • Increase opportunities for peer support • Improve morale, retention, productivity
  • 158. Programs• Information and referral programs• Caregiver support• Lunch-and-learns• Employee health fairs• Support for employees coping with grief
  • 159. Benefits and PoliciesGoals:• Improve company’s competitive advantage in recruiting• Improve employee morale• Increase retention and productivity
  • 160. Benefits and PoliciesAssess, modify and/or add:• Funeral leave• Bereavement leave• Sick leave• Leave of absence• Alternative work schedules
  • 161. Benefits and Policies• Action Steps • Make sure that employees know about benefits and policies • Provide ongoing training for supervisors • Involve staff in the design of benefits and policies • Respect the privacy and confidentiality of employees
  • 162. Communication Resources• Templates for posters & flyers• Newsletter articles• PowerPoint presentation for leadership
  • 163. Learning Modules• End-of-life Issues in the Workplace• Supporting Working Caregivers www.caringinfo.org/employer
  • 164. Outcomes from Pilot• The assessment process uncovered a greater need than previously thought• Managers more aware of employee needs• Brochures rated as very useful• Presentations from local hospice were extremely informative• Support after sudden death “invaluable”
  • 165. Tools You Can Use• Caring Connections - www.caringinfo.org• Employer’s Guide• Educational brochures• Outreach Guide• National Healthcare Decisions Day – www.nationalhealthcaredecisionsday.org
  • 166. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation
  • 167. Closing PlenaryJennie Chin Hansen, CEO, American Geriatrics Society
  • 168. Summit GoalsA greater understanding of the issues and challenges, their causes andpotential solutions among American society and leadership: health careconsumers; faith-based organizations; clinicians; health insurance plans;employers; policy makers; and public advocates, including thoserepresenting culturally diverse communities.A shared sense of mission and action steps needed to reform and improveadvanced illness care in America, including: system innovations; publicengagement; policy changes; and health professional education andsupport. The emphasis will be on quality care and patient satisfaction, andan agenda that addresses COMMUNITIES, individuals, systems, and policy.
  • 169. Cost and BenefitsBuild on new and existing data from innovative advanced caremanagement models that improve patient/family quality oflife, lower costs, and affect other key metrics, to identify waysto improve data and evidence on supporting greaterbenefit/value through health care reform.
  • 170. Public EngagementHighlight best-practices/innovations in public engagementincluding: receptive audiences, effective messages, metrics,and dissemination strategies.Create awareness of the need for programmatic coordinationamong public engagement initiatives -- specifically, related todeveloping and coordinating a common language about theterms to use and shared messaging.
  • 171. Professional EducationBuild consensus around the competencies clinicians need todeliver high quality advanced illness care.Raise awareness of existing innovative tools and solutions inclinician support and training.Empower champions within health care systems to advocatefor curricula transformation.
  • 172. Clinical ModelsIdentify clinical best practices in caring for people with advanced illness withthe potential to effectively serve the advanced illness population across thecountry.Achieve consensus on common process and outcomes measures that can beused to assess the clinical effectiveness and patient and family satisfaction withtreatment of advanced illness.Agree on the structure of a national pilot that can be used to scale and replicateeffective innovations in advanced illness care and to create an evidence basethat is critical to advocacy for payment reform.
  • 173. Empowering EmployersThink about ways in which your organization can take steps to increaseits support of employee caregivers. This can include items that are top-down such as flexible leave time and geriatric care managers orbottom-up such as brown bag info sessions and support groups.Review the Employer Checklist and share with your colleagues. Takeproactive steps to implement one or more of the recommendations.
  • 174. Faith & DiversityImprove the quality of spiritual care across settings by reducing variations in thequality of care, particularly for traditionally under-served and marginalizedpopulations.Have clergy and faith communities help their members become more health careliterate and invite discussion and dialogue about how their faith, beliefs, and valuesinform their health care choices.Credential clinicians and other health care professionals caring for persons withadvanced illness based on their demonstrated ability to provide compassionate, highquality, whole person centered care, and to attend to the physical, psycho-social,and spiritual domains of care.
  • 175. Policy & AdvocacyIdentify policy barriers to fundamental system change leading tomore person-centered, comprehensive, team-based approaches tocaring for Americans with advanced illness and lay out a roadmap toreform with legislative and regulatory remedies to overcome thosebarriersDesign a targeted public engagement and advocacy campaign usingidentified networks and working with messaging experts oncommunication to create a grassroots and grasstops movement forchange
  • 176. Policy & AdvocacyAction Steps from the Perspectives from the U.S. Senate: AchievingHigh-Quality Advanced Illness Care for Our Seniors Panel:•Developing a Brand/Common Terminology•Supporting CMMI Innovation Challenge Awards/Pilots•Partnering with Faith Leaders
  • 177. Stay Engaged With C-TACFor more information on joining C-TAC and participating in anyof our workgroups please visit: www.thectac.org or emailctac@advancedcarecoalition.org.Keep up with C-TAC on Twitter at: @CTACorg
  • 178. 2013 National Summit on Advanced Illness Care A Roadmap for Transformation