Coalition to Transform Advance CareCoalition to Transform Advance Care (C-TAC)(C-TAC)

A national non-profit, non-partisan alliance A national non-profit, non-partisan alliance of patient and consumer advocacy groups, of patient and consumer advocacy groups,

health care professionals and providers, health care professionals and providers, private sector stakeholders, faith-based private sector stakeholders, faith-based organizations, and health care payers organizations, and health care payers

united by shared principles.united by shared principles.

• C-TAC’s Vision:C-TAC’s Vision: All Americans with All Americans with advanced illness, especially the sickest and advanced illness, especially the sickest and most vulnerable, will receive comprehensive, most vulnerable, will receive comprehensive, high-quality, person- and family-centered care high-quality, person- and family-centered care that is consistent with their goals and values that is consistent with their goals and values and honors their dignity.and honors their dignity.

• C-TAC’s Mission:C-TAC’s Mission: To transform advanced To transform advanced illness care by empowering consumers, illness care by empowering consumers, changing the healthcare delivery system, changing the healthcare delivery system, improving public and private policies, and improving public and private policies, and enhancing provider capacity.enhancing provider capacity.

Key Policy ComponentsKey Policy Components

1.1. Personal care planningPersonal care planning 2.2. Consumer & family caregiver Consumer & family caregiver

education, information & supporteducation, information & support 3.3. Quality standardsQuality standards4.4. Professional educationProfessional education5.5. Payment mechanismsPayment mechanisms6.6. Health and health information Health and health information

technologytechnology 7.7. ResearchResearch

Barriers to Achieving SuccessBarriers to Achieving Success

Barriers include clinical, social, cultural, & Barriers include clinical, social, cultural, & political elements all requiring simultaneous political elements all requiring simultaneous interventions to overcome:interventions to overcome:

1.1. Payment and Delivery Systems barriers:Payment and Delivery Systems barriers: Conflicting goals, uncoordinated, unsupportive careConflicting goals, uncoordinated, unsupportive care Delivered in separate, loosely affiliated silosDelivered in separate, loosely affiliated silos Paid for through separate, uncoordinated silosPaid for through separate, uncoordinated silos Covering treatment often unreasonable for the Covering treatment often unreasonable for the

circumstance, inconsistent with informed choice & circumstance, inconsistent with informed choice & good qualitygood quality

Overlooking social services and supports in the Overlooking social services and supports in the communitycommunity

Resulting in families being forced to find their own Resulting in families being forced to find their own way through the maze with little support.way through the maze with little support.

Barriers to Achieving SuccessBarriers to Achieving Success

2.2. Lack of public dialogue Lack of public dialogue

3.3. Lack of health system standards of Lack of health system standards of care for Advanced Illness and care for Advanced Illness and coordination coordination

4.4. Workforce inefficiencies/shortagesWorkforce inefficiencies/shortages

What Will Overcome These Barriers?What Will Overcome These Barriers?

1.1. Agreed upon Goals & Standards with incentives Agreed upon Goals & Standards with incentives and regulatory framework that supports them.and regulatory framework that supports them.

2.2. Increase Public Awareness of the Impact of Increase Public Awareness of the Impact of

Advanced Illness. Advanced Illness. • To educate people on the need for reform in To educate people on the need for reform in

advanced illness care (grass-roots, grass-advanced illness care (grass-roots, grass-tops, and strategic media outreach)tops, and strategic media outreach)

3.3. Ensure the Highest Quality in Advanced Illness Ensure the Highest Quality in Advanced Illness Care.Care.

• Develop Comprehensive Quality Measures. Develop Comprehensive Quality Measures. • National Leader for Advanced Illness National Leader for Advanced Illness • Coordinate research effortsCoordinate research efforts

What Will Overcome These Barriers?What Will Overcome These Barriers?  4.4. Bolster Professional Education for Bolster Professional Education for

Advanced Illness Advanced Illness • Strengthen current workforce Strengthen current workforce 

• Expanding workforce capacity Expanding workforce capacity 

• Regulatory and administrative.  Regulatory and administrative.  

4.4. Ensuring Advanced Illness Care Ensuring Advanced Illness Care Services. Services. • Promote evidenced-based policies aimed at Promote evidenced-based policies aimed at 

modifying federal payment mechanisms in modifying federal payment mechanisms in order to ensure coverage for advanced illness order to ensure coverage for advanced illness care coordination servicescare coordination services

Examples of Promising ModelsExamples of Promising Models

• Sutter Health’s Advanced Illness Management Sutter Health’s Advanced Illness Management (AIM)(AIM)  program reduced hospitalization rates by  program reduced hospitalization rates by over 60% at 30, 60, and 90 days.  Direct inpatient over 60% at 30, 60, and 90 days.  Direct inpatient costs reduced by $2000 per enrollee per mo. on costs reduced by $2000 per enrollee per mo. on average.  Patient and physician satisfaction high. average.  Patient and physician satisfaction high. 

• The Aetna Compassionate CareThe Aetna Compassionate CareSMSM program program, , decreased hospitalization from 88 to 30%; inpatient decreased hospitalization from 88 to 30%; inpatient days/1000 patients decreased by 82% and ICU days/1000 patients decreased by 82% and ICU days/1000 were reduced by 86% days/1000 were reduced by 86% 

• Gundersen Health SystemGundersen Health System..  Total Medicare   Total Medicare reimbursement and hospital days for patients in the reimbursement and hospital days for patients in the last 2 years of life are 29% and 43% lower last 2 years of life are 29% and 43% lower respectively than national average.  Recent study respectively than national average.  Recent study showed 99.4% of patients had an advance directive showed 99.4% of patients had an advance directive in the medical record at the time of death, and in in the medical record at the time of death, and in 99.5% of cases, medical treatment was in accord 99.5% of cases, medical treatment was in accord with patient wishes. with patient wishes. 

Examples of Promising ModelsExamples of Promising Models

• Home-Based Primary Care (HBPC),Home-Based Primary Care (HBPC), US Veterans US Veterans Health Administration, was shown in 2002 to Health Administration, was shown in 2002 to reduce hospital bed days by 62%, nursing home reduce hospital bed days by 62%, nursing home days by 88%, and a concomitant increase in all days by 88%, and a concomitant increase in all home visits by 264%. The net mean total cost of home visits by 264%. The net mean total cost of care was reduced by 24%. care was reduced by 24%.

• Ascension Health,Ascension Health, 7 palliative care pilot sites est.d 7 palliative care pilot sites est.d in 2006 based on the 8 domains of quality in 2006 based on the 8 domains of quality identified by the National Consensus Project’s identified by the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Clinical Practice Guidelines for Quality Palliative Care. Patients were seen earlier in their disease Care. Patients were seen earlier in their disease process. Over 90% patients had pain & dyspnea process. Over 90% patients had pain & dyspnea controlled within 48 hours of admission. All had controlled within 48 hours of admission. All had spiritual assessments within the 1st day of spiritual assessments within the 1st day of admission. Significant increase in the completion admission. Significant increase in the completion of advance directives. One site (Troy, NY) had 1 of advance directives. One site (Troy, NY) had 1 mo. readmission rate of 1% and a 60 day mo. readmission rate of 1% and a 60 day readmission rate of only 3%.readmission rate of only 3%.

Examples of Promising ModelsExamples of Promising Models

• Medicare and Medicaid’s PACE programMedicare and Medicaid’s PACE program – a – a comprehensive community-based care model for comprehensive community-based care model for frail, chronically ill older adults whose significant frail, chronically ill older adults whose significant functional and cognitive impairments make them functional and cognitive impairments make them nursing home eligible. Research shows improved nursing home eligible. Research shows improved quality of care and access to services based on quality of care and access to services based on need, fewer hospitalizations, fewer nursing home need, fewer hospitalizations, fewer nursing home admissions, higher contact with primary care, admissions, higher contact with primary care, longer survival rates, increased number of days in longer survival rates, increased number of days in the community, better health, better quality of life, the community, better health, better quality of life, greater satisfaction with overall care greater satisfaction with overall care arrangements, and better functional status.arrangements, and better functional status.