Dying Better in America

Argentum 2016 Senior Living

Executive Conference

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"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

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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

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“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

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"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)

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"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.

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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

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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

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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.

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Care Continuum

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IOM report,

“Dying in America:

Improving Quality

and Honoring

Individual

Preferences Near

the End of Life.”

September, 2014

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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

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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

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C-TAC’s Goal

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“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

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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

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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

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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

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A Roadmap for Success

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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

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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

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Let’s Get This Right

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• 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.

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