Palliative Care Interdisciplinary Advisory Council (PCIAC)June 11, 201910:00 AM

1

Meeting Overview Main Objectives

2

• Welcome and Introductions• Review and approve meeting minutes • Review 86th Texas Legislative session and SB 916• Discuss palliative care payment models• Plan for 2019

• Palliative care study• Palliative care website• Continuing education event

• Hear from stakeholders

Palliative Care Interdisciplinary Advisory Council

Welcome and introductions

3

Palliative Care Interdisciplinary Advisory CouncilReview and approval of meeting minutes from February 27, 2019

4

Palliative Care Interdisciplinary Advisory Council

86th Texas Legislative Session Update

5

Senate Bill 916: Overview• Adds a new chapter to the Health and Safety

Code (Chapter 142A) defining supportive palliative care distinct from hospice care

• Authorizes HHSC to conduct a study on Medicaid reimbursement for supportive palliative care

• Adopted by each house with a greater than two-thirds majority

Senate Bill 916: Definition• Defines supportive palliative care as physician-

directed interdisciplinary patient- and family-centered care provided to a patient with a serious illness without regard to the patient’s age or terminal prognosis that:

• May be provided concurrently with methods of treatment or therapies that seek to cure or minimize the effects of the patient’s illness

• Seeks to optimize the quality of life for a patient with a life-threatening or life-limiting illness and the patient’s family

Senate Bill 916: Definition• Methods for optimizing quality of life include

those seeking to:

• Anticipate, prevent, and treat the patient’s total suffering related to a physical, emotional, social, and spiritual condition

• Address physical, intellectual, emotional, cultural, social, and spiritual needs of the patient

• Facilitate for the patient treatment options, education, informed consent, and expressions of desires

Senate Bill 916: Study• Assess potential improvements to quality,

outcomes, and costs from the availability of supportive palliative care services in Medicaid

• Must include an evaluation and comparison of other states that provide Medicaid reimbursement for supportive palliative care

• The Palliative Care Interdisciplinary Advisory Council will provide recommendations on the study

• HHSC may collaborate with and solicit and accept gifts, grants, and donations to fund the study

• Study not required if money not received for this purpose

• Study findings due by September 1, 2022

Palliative Care Interdisciplinary Advisory Council

Palliative Care Data and Program Update

10

Palliative Care Inpatient ProgramsHospitals Reporting Palliative Care Service Programs, U.S. &

Texas, 2012-2017

Source Year Original Grade

Updated Grade

CAPC U.S. 2012/2013 67% 67%

CAPC Texas 2012/2013 43% 43%

In-house Texas 2014 42% 47%

In-house Texas 2015 46% 56%

In-house Texas 2016 49% 59%

In-house Texas 2017 NA 62%

Note: Results are based on CAPC cohort definitions. Analyses were limited to general medical and surgical, cancer, or heart hospitals with fifty or more licensed beds based on data from the American Hospital Association Annual Survey of Hospitals. Veterans Administration and Indian Health Service facilities wereexcluded.

Palliative Care Interdisciplinary Advisory Council

Alternative Payment Models

12

Payment Models for Serious Illness

• U.S. Department of Health and Human Services (HHS) advanced two alternative payment models designed to support people living with serious illness.

• The models were recommended by the Physician-Focused Payment Model Technical Advisory Committee’s (PTAC).

1. Advanced Care Model (ACM) 2. Patient and Caregiver Support for Serious

Illness (PACSSI)Link: https://www.thectac.org/2018/03/hhs-panel-advances-c-tac-and-aahpms-payment-model-proposal/

Palliative Care Interdisciplinary Advisory Council

Palliative Care Study Options

14

Senate Bill 916: Study Options• Charges the Council to provide recommendations

on structure, including:• Specific populations of Medicaid recipients• Variables• Outcomes to measure

• Example issues for exploration• What are current Medicaid benefits• Effectiveness of inpatient interdisciplinary programs, including

by specific, measurable characteristics (e.g., accreditation status)

• Benefits of advance care planning in Medicaid• Community-based benefits/models• Dual eligible (Medicare/Medicaid eligibility) recipients• Concurrent care model outcomes• Intersection with MCO APMs initiative• DSRIP impacts

Senate Bill 916: Study Options• Considerations/barriers/opportunities:

• Availability of data• Medicaid• Medicare• Other payers• Other states

• Potential partners• Academic• MCOs• Healthcare Systems and Organizations

• Funding opportunities/strategies• Programmatic funds• Solicited grant applications• Unsolicited grant proposals• Gifts/donations

Palliative Care Interdisciplinary Advisory Council

Palliative Care Websitehttps://hhs.texas.gov/services/health/palliative-care

17

Palliative Care Website Link

18

Palliative Care Interdisciplinary Advisory Council

Palliative Care Continuing Education Event

19

Continuing EducationFall continuing education (CE) event• Goals:

• Credit for multiple disciplines• Include at least one ethics credit• Live event available in person and through webinar

• Previous CE topics have included: 2016 and 2018 legislative reports, state and national policy options, advance care planning, Do-Not-Resuscitate orders, and opioid prescribing

• Establish a Planning Committee to work with program staff and Department of State Health Services

20

Continuing EducationFall CE eventProposed Timeline• June/July

• Determine CE topics, presenters, and Planning Committee members

• Work with presenters and Planning Committee to organize event and complete CE packet: • Planning committee disclosure forms• Speaker biographical information• Learning needs assessment/learning objectives• Program structure and content• Evaluation

21

Continuing EducationFall CE eventProposed Timeline, cont. • August/September

• CE packet due (60 days prior to event)• Promotional efforts• Registration form/link to webpage• Save the date announcement• Promotional efforts• Registration

• October or November• CE event (Proposed: October 9 or November 5)• Post event: evaluation and certification

22

Palliative Care Interdisciplinary Advisory Council

Work Plan, 2019-2020

23

Advancing Palliative Care in TexasWork plan purposeEnsure that relevant, comprehensive, and accurate information and education about palliative care, including complex system management, care planning, and coordination needs to address the physical, emotional, social, and spiritual suffering associated with serious illness is available to the public, health care providers, and health care facilities.

24

Advancing Palliative Care in TexasHigh level work plan aims• Improve patient and family awareness

and access to information• Increase professional education and

promote workforce development• Develop and report on best available

evidence for policymaking• Measure and report on progress

25

Advancing Palliative Care in TexasPotential Work Plan Activities

26

• Revise website• Update and host continuing education event• Develop consensus proposal for standards and quality for

supportive palliative care (SPC) in Texas• Identify and report performance metrics for SPC in Texas• Identify funding opportunities for SPC study• Provide recommendations for SPC study• Further palliative care as a value-based model in the Texas

Medicaid program• Develop 2020 legislative report

PCIAC Timeline

*This is a draft timeline and the listed dates are tentative. 27

June

June 11th

Full Council Meeting:Review

legislative sessionBegin

preliminary discussion for 2020

legislative report

Establish workgroups

JULY

2019 Milestones(Proposed)

July: Workgroup (WG) calls with Chairs and leadsDevelop website update

proposalCE Event planningDevelop study

proposal

AUG

Aug: Sept:

WG calls to discuss topics and conduct background

researchCE Event promotion

SEPT

Sept:WG calls to discuss topics and conduct back-

ground researchCE EventPromotion

OCT

OctFull Council

Meeting:Each WG will present on progress.

Council will continue to seek

stakeholder input.

Website updates approved

Host CE Event

NOV

Nov:WG calls to

discuss council meeting

feedback and next stepsCE Event follow-up

DEC

Full Council Meeting (TBD)

Finalize recommendations

for study

PCIAC Timeline

*This is a draft timeline and the listed dates are tentative. 28

JAN

Jan: Full Council Meeting

Finalize report topics

Approve study recommendations

FEB

2020 Milestones(Proposed)

Feb/MarRecommendation templates due to

the communications subcommittee

(CSC)Council

appointments/ reappointments

MAR

Feb-AprProposed

recommendation language drafted

WG calls are conducted as

needed.

APR

Apr 17:CSC

develops draft

language for the report.

MAY

May: Full Council Meeting

Report recommendationlanguage adopted

Available draft report language reviewed and

updatedUpdate on study

progress.

JUN

JuneComplete first

draft

Jan-Feb:WG calls to

work on recommendation

templates

PCIAC Timeline

*This is a draft timeline and the listed dates are tentative. 29

JUL

Jul 1st: Distribute report

to the council and stakeholders for

review of the draft report.

AUG

2020 Milestones(Proposed)

Aug: Full Council Meeting

Receive final comments from

stakeholders Approve final

report Discuss report education and

follow upReview progress

on study

SEP

Sept:Post meeting report edits

Chair transmits report to the legislature

OCT

Oct:Official due

date for report is

October 1.

NOV DEC

Dec: CSC workgroup meets to discuss report education and follow up.

Jul:Solicit

Stakeholder comments.

Nov: Full Council

MeetingHost CE Event

Review progresson study

Palliative Care Interdisciplinary Advisory Council

30

Staff action items

Palliative Care Interdisciplinary Advisory Council

Public Comment

Onsite participants, please come to the podium and provide your name and organization for the record.

Comments may also be submitted in writing to staff to be read aloud or for inclusion in the meeting record.

31

Thank youFor more information contact:Jimmy Blanton, DirectorHealth Quality Institute Medicaid and CHIP ServicesJimmy.Blanton@hhsc.state.tx.us

Visit the PCIAC Advisory Council webpage to learn more:

https://hhs.texas.gov/about-hhs/leadership/advisory-committees/palliative-care-interdisciplinary-advisory-council