Development of a serious illness care model implementation framework.

Abstract

161 Background: Care of individuals with cancer and other serious illness is complex and often results in unmet needs and high costs. Despite growing national interest in innovative care models for serious illness that improve quality and reduce costs, limited information is available to guide health care organizations from program innovation to implementation. Methods: With funding from the Gordon and Betty Moore Foundation, we sought to develop a flexible serious illness care model implementation framework to inform program development, replication, and scaling across a broad range of serious illness populations and settings. A draft framework was developed, guided by review of white papers and peer reviewed evidence and of existing serious illness care programs. Expert panelists—representative of serious illness care providers, policy experts, payers, and researchers—were recruited to review and provide feedback in two rounds of group discussion and additional 1:1 interviews. Results: The resulting framework implementation process begins with setting a vision and completing a local needs assessment. We present a range of evidence-based options for each facet of care model implementation (e.g., possible business models, target populations, services, and outcomes) to guide healthcare organizations in adapting serious illness programs to their local context. Key considerations for encouraging program success include leveraging existing programs and resources, recruiting strong program leaders, engaging staff, assembling experienced multidisciplinary care teams, building strong relationships among team members and with patients/caregivers, and establishing processes for program evaluation and continuous quality improvement. Conclusions: Our framework reflects a growing landscape of care models for cancer and other serious illness, offering a range of potential approaches to program implementation. Next steps include dissemination, framework impact assessment, creating a simulator for payment models, and piloting framework for use with future programs.