Advanced Care Model Honors Dignity, Integrates Health System For Seriously Ill People And Loved Ones

Abstract

Editor’s Note: This post is the second in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. This post describes the Advanced Care model, a delivery system approach that includes palliative care and coordinates services for people with serious chronic illness across hospitals, medical groups, homes, and the community. Like other initiatives to reform American health care, the movement to improve care for patients with advanced illness does not suffer from a lack of new ideas. The real barriers to improvement lie in replicating innovative models that have already addressed the problem and found scalable and sustainable solutions. Fortunately, promising initiatives are now prepared to transform care on a national scale. These developments are timely because reform is badly needed. Our fragmented approach to advanced illness exacts a terrible toll from our sickest and most vulnerable citizens and their families. It also places a growing burden on our health care system. Hospital treatment of advanced illness absorbs a large fraction of the Medicare budget. Over one quarter of all Medicare expenditures pay for care in the last year of life, a proportion that has not changed in 35 years. CMS research shows that about 30 percent of this final-year spending is concentrated in the month prior to death, and 80 percent of Medicare dollars spent during that final month go toward hospital treatment. People suffering from advanced illness – multiple chronic conditions with declining function and poor prospects for full recovery – often fall through the cracks between current programs and providers. Like patients under disease management, people with advanced illness have multiple chronic conditions, but their decline in health and function is more pronounced, faster, and in many cases, irreversible. In short, a person with advanced illness has entered the “gray zone” between treatable and terminal illness.