Assessing Progress in End-of-Life and Serious Illness Care May 23, 2016

Dying in America: 18 Months Later Victor J. Dzau President, National Academy of Medicine

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of

Dying in America: Recommendations Overview Recommendation 1: Public and private payers and care delivery organizations should cover the provision of comprehensive care. Recommendation 2: Professional societies and others should establish quality standards for communication and advance care planning. Payers and care delivery organizations should adopt these standards. Recommendation 3: Educational institutions, credentialing bodies, accrediting board, state regulatory agencies, and care delivery organizations should establish palliative care training, certification, and/or licensure requirements. Recommendation 4: Public and private payers and care delivery organizations should integrate the financing of health and social services. Recommendation 5: Public and private organizations of many kinds should engage their constituents and provide fact-based information to encourage advance care planning and informed

Dissemination Public report release and media outreach “Next Steps for Stakeholders” Webinar “What Should You Know About Palliative Care?” Poster Special Briefing, National Institute for Nursing Research National Action Conference on Policies and Payment Systems to Improve End-of-Life Care “It’s Time to Have the Conversation” Public Service Announcement Conversations About Care at the End of Life: Podcast Series for

Facing Our Fears

Examples of Progress CMS decision to reimburse physicians for EOL counseling CMS’s recent proposal to raise payment rates for hospice, skilled nursing, and rehab facilities Senate Bipartisan Chronic Care Working Group Massachusetts Coalition for Serious Illness Care “Conversation Stopper” poll VHS proposal to permit simultaneous access to VA benefits while also receiving hospice care under Medicare Aspen Health Strategy Group

@theNAMedicine

Examples of Progress American Nurses Association & Hospice and Palliative Nurses Association Palliative and Hospice Nurses Professional Issues Panel American Geriatrics Society & American College of Physicians Statement of need for a focus on geriatrics education and training for providers National Multiple Sclerosis Society New effort to address EOL issues in the context of advanced MS care

@theNAMedicine Examples of Progress Kaiser Permanente’s In-Home Palliative Care Program 33 percent reduction in total medical expenditure and 55 percent reduction in average cost per day 2.2 times greater likelihood of dying at home Hospice and Palliative Nurses Credentialing Center More than 17,000 individuals certified as of April 1, 2016 Coalition to Transform Advanced Care Report of the Advanced Care Project Cambia Health Solutions 1.7 million plan members have access to Personalized Care Support palliative care program 94 percent satisfaction score from patients Hospital readmissions reduced from 30 percent to 25 percent

@theNAMedicine Targeting Underserved Populations American Geriatric Society Position statement on care for older LGBT adults National Hospice and Palliative Care Organization Collaboration with historically black colleges and universities Cambia Health Foundation Collaboration with Familias en Accion Children’s National Medical Center Direct-to-consumer telehospice program

@theNAMedicine NAM Impact Assessment Questionnaire 496 responses

@theNAMedicine NAM Impact Assessment Questionnaire Has EOL care improved, stayed the same, or gotten worse in the past 18 months? Improved 34% Stayed the same 53% Gotten worse 9%

@theNAMedicine NAM Impact Assessment Questionnaire Care delivery Yes 54% No 39% No 37% Yes 59% Communication & ACP No 29% Yes 65% Professional ed & development No 45% Yes 45% Policies & payment systems No 34% Yes 63% Public education & engagement Have we improved in specific areas?

Roundtable on Quality Care for People with Serious Illness Chair: Leonard D. Schaeffer, University of Southern California Vice Chair: James A. Tulsky, MD, Harvard Medical School 1.Ascension Health 2.Association of Professional Chaplains 3.BlueCross BlueShield Association 4.BlueCross Blue Shield of MA 5.Blue Cross BlueShield & MedAmerica Insurance Company 6.Cambia Health Solution 7.Childrens National Health System 8.Common Practice 9.Dignity Health 10.The John A. Hartford Foundation 11.National Hospice and Palliative Care Organization 12.Compassion & Choices 13.Association of Rehabilitation Nurses 14.Patient-Centered Outcomes Research Institute 15.Gordon and Betty Moore Foundation 16.National Quality Forum 17.The Pew Charitable Trusts 18.Health Care Chaplaincy Network 19.Harvard Medical School 20.Federation of American Hospitals 21.National Patient Advocate Foundation 22.Coalition to Transform Advanced Care (C-TAC) 23.Centers for Medicare & Medicaid Services 24.The Greenwall Foundation 25.Altarum Institute 26.Clinical Strategy, Anthem, Inc. 27.Center to Advance Palliative Care 28.National Coalition for Hospice and Palliative Care 29.National Institute of Nursing Research, NIH 30.UnitedHealth Group 31.Icahn School of Medicine at Mount Sinai 32.Oncology Nursing Society 33.Aetna 34.Social Work Hospice and Palliative Care Network 35.Stanford University School of Medicine 36.Cedars-Sinai Health System 37.Hospice and Palliative Nurses Association 38.Kaiser Permanente 39.Susan G. Komen 40.Cancer Support Community 41.American Cancer Society 42.American Geriatrics Society 43.American Academy of Hospice and Palliative

Thank you