Leonard D. Schaeffer's slides from the Center for Health Journalism webinar "Webinar: Can Our Health Care System Provide a ‘Good Death’?" 9.29.16 http://www.centerforhealthjournalism.org/content/can-our-health-care-system-provide-good-death

1. Leonard D. Schaeffer
Judge Robert Maclay Widney
Chair and Professor,
University of Southern California
September 29, 2016
Health Matters Webinar:
Can Our Health Care System Provide a
“Good Death”?

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• In last century, death has evolved from a family
event to a medical event
• Many die in circumstances that do not reflect
their values or preferences
• A more culturally diverse population means
clinicians cannot make assumptions about the
care choices patients might make
• A fragmented care delivery system with
perverse financial incentives contributes to
uncoordinated care and unnecessary costs
Dying in America (DIA):
Why Improve End-of-Life Care?

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1. Delivery of person-centered, family-oriented
care
2. Clinician-patient communication and advance
care planning
3. Professional education and development
4. Policies and payment systems
5. Public education and engagement
DIA Recommends Change in 5 Key Areas
to Transform End-of-Life Care

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What Does DIA Recommend?
1. Delivery of person-centered, family-
oriented care
• Health care delivery organizations should provide
integrated, person-centered, family-oriented and
consistently accessible care near end of life
• Government and private health insurers should
cover and pay for these services
• Care should be transparent and accountable
through public reporting of quality and costs

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• The advance care planning process should center on
frequent conversations with patients, family members
and providers and should be electronically stored
• Professional societies and other organizations should
develop standards for clinician–patient
communication and advance care planning
• Payers and health care delivery organizations should
adopt these standards
What Does DIA Recommend?
2. Clinician-Patient Communication and
Advance Care Planning

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• Educational institutions, professional societies,
accrediting organizations, certifying bodies, health
care delivery organizations and medical centers
should:
Ø Establish training, certification, and/or licensure
requirements for palliative care knowledge/skills
Ø Increase the number of palliative care specialists
Ø Expand the knowledge base for all clinicians
What Does DIA Recommend?
3. Professional Education & Development

7. • Payment systems should undergo a major reorientation
to incentivize:
Ø Integration of medical and social services
Ø Coordination of care across multiple care settings
Ø Use of advance care planning and shared decision making
• Congress should enact legislative changes if
necessary
• Federal government should require public reporting on
quality measures, outcomes, and costs of care near
end of life for its programs
What Does DIA Recommend?
4. Policies & Payment Systems
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• Public education and engagement about end-of-life
care planning is needed at the societal, community
and family, and individual levels
• A range of organizations should engage constituents
and provide fact-based information about care to
encourage advance care planning and informed
choice
• Disseminating accurate information is critical to
ensure individual care decisions are based on fact
What Does DIA Recommend?
5. Public Education & Engagement

9. If DIA Recommendations Were Implemented:
What Would End-of-Life Care Look Like?
Patients
Respected
• Medical and social services would reflect patients’ values,
goals, preferences and condition, and allow for their needs
and service intensity to change over time
Crises
Prevented
• Comprehensive, person-centered and family-oriented care
would reduce preventable crises, repeated 911 calls, ER
visits, and hospital admissions
Costs
Stabilized
• High-quality patient-centered care could help stabilize
aggregate societal expenditures for medical and social
services, and potentially lowers their costs
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ü Public is way ahead of policymakers, health care
organizations and the media on this issue…
ü Many Americans have had a difficult experience with
the final days of a family member or dear friend…
ü Dying in America report captures the human interest
and the data, and provides a roadmap for change…
A movement to change how we die is underway:
journalists can educate the public about policy & personal
options to help accelerate cultural and systemic change
Opportunity for Journalists:
Everybody Has a Story