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Argentum 2016 Senior Living Executive Conference concurrent session Original session date: Tuesday, May 10, 2016, 1:30 - 2:45 PM Speaker: Bill Novelli, Professor, McDonough School of Business at Georgetown University; Founder, Coalition to Transform Advanced Care
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Argentum 2016 Senior Living
Executive Conference
1
"Building a Movement -- To Change the
Way America Treats Our Seriously Ill”
Bill Novelli, Coalition to Transform Advanced
Care (C-TAC) and Georgetown University
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
3
“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
5
"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
“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)
6
"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.
7
The Challenge of Advanced Illness
TodayThe 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
8
Often die in hospital, in pain
and isolation
The Big Gap…
1. Be at home with family,
friends
2. Have pain managed
3. Have spiritual needs
addressed
4. Avoid impoverishing
families
Often unwanted, ineffective
treatment
At great cost to families and
the nation.
What People Want What They Get
Recycled through the
hospital
9
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.
10
Care Continuum
11
IOM report,
“Dying in America:
Improving Quality
and Honoring
Individual
Preferences Near
the End of Life.”
September, 2014
12
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
14
C-TAC’s Goal
15
“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.”
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 person-
centeredness (with patient/family
satisfaction)
• Work with NQF, NAM, others to
establish accepted metrics
19
A Roadmap for Success
20
A field guide for action
to achieve high-quality advanced illness care.
“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
23
• 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 %.
"We all want to be the authors of our lives.”
- Atul Gawande, M.D.
24
25