Center to Advance Palliative Care 801.538.5082 | - - PowerPoint PPT Presentation

Center to Advance Palliative Care

801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107

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• There will be several opportunities for questions. Please

submit them using the Zoom question box

• Just a few announcements from the ACLC

AGENDA

• ACLC updates
• Introduction of guest presenters
• The Benefits of Palliative Care by Dr. Diane

Meier, CAPC

• Palliative Care in Action by Dr. Daniel Hoefer,

Sharp Healthcare

• Opportunity for Q&A

– Members can submit questions ahead of time by using the question box of the Zoom window

UPCOMING MEMBER EVENT(S)

ACLC Member Meeting at HIMSS17 Orlando, FL

February 20th

• Co-located with the HIMSS17 Annual Conference
• Members of the ACLC are invited to attend a second Healthcare Conference day on Tuesday,

February 21st hosted by Leavitt Partners

Look for registration links in weekly news every Tuesday

THE BENEFITS OF PALLIATIVE CARE IN VALUE-BASED PROGRAMS

Diane E. Meier, MD Director, Center to Advance Palliative Care Daniel Hoefer, MD CMO Palliative Medicine Sharp Healthcare

GUEST PRESENTER

• Dr. Diane Meier

Director, Center to Advance Palliative Care Icahn School of Medicine at Mount Sinai

WHAT IS PALLIATIVE CARE?

• An added layer of support for

quality of life- relief of pain, symptoms and stresses of serious illness

• Provided by an interdisciplinary

team that works closely not

• nly with treating physicians,

but also with family caregivers

• Appropriate at any age and any

stage of a serious illness

• Should be provided concurrent

with disease treatment

• MR. B
• An 88 year old man with

dementia admitted via the ED for management of back pain due to prostate cancer, spinal stenosis and arthritis.

• Pain is 8/10 on admission,

for which he is taking 5,000 mg of acetaminophen/day.

• Admitted 3 times in 2

months for pain (2x), falls, and altered mental status due to constipation.

• His family (83 year old wife)

is overwhelmed.

MR B: BEFORE AND AFTER

Usual Care

• 4 calls to 911 in a 3 month period,

leading to

• 4 ED visits and
• 3 hospitalizations, leading to:

– Hospital acquired infection – Functional decline – Family distress

Palliative Care

• House calls referral
• Pain management
• 24/7 phone coverage
• Support for caregiver
• Meals on Wheels
• Friendly visitor program
• No 911 calls, ED visits, or

hospitalizations in last 18 months

WHO BENEFITS FROM PALLIATIVE CARE?

• Cancer
• Advanced liver

disease

• COPD with oxygen
• CHF, Stroke
• Trauma
• Renal failure
• Dementia
• Diabetes with severe

complications

• ALS
• Frailty

Serious illness

• Limitations in

Activities of Daily Living (eating, bathing, dressing, toileting, transferring and walking)

• Exhausted family

caregivers

Functional Limitations

• 911 Calls
• Emergency

Department visits

• Hospital admissions
• Skilled nursing and

rehab stays

• Home nursing

and/or rehab

High Utilization

Graphic adapted from the National Consensus Project for Quality Palliative Care

11%

49% 40%

Costliest 5% of Patients

IOM Dying in America Report Appendix E

http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual- Preferences-Near-the-End-of-Life.aspx

Last 12 months of life Short term high $ Persistent high $

Only a small portion of these patients are in the last year of life. Focus on end-of-life and prognosis misses the big

• pportunity for

Improvement.

EARLY AND CONCURRENT PALLIATIVE CARE MAKES A DIFFERENCE . . .

Randomized trial simultaneous standard cancer care with palliative care co-management from diagnosis versus control group receiving standard cancer care only:

– Improved quality of life – Reduced major depression – Reduced ‘aggressiveness’ (less chemo < 14d before death, more likely to get hospice, less likely to be hospitalized in last month)

– Improved survival (11.6 mos. vs 8.9 mos.,

p<0.02)

Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM2010;363:733-42.

. . . AND LEADS TO COST AVOIDANCE

Setting Results Studies Inpatient Hospital Palliative Care $1,696 costs saved per admission for live discharges; $4,908 for death 43% fewer ICU admissions (Morrison, 2008) (Gade, 2008) Office-Based Palliative Care In Primary Care: 20% fewer hospital admissions $117/day in oncology practice (Trisolini 2006) (Greer 2016) Home-Based Primary and Palliative Care 33% lower costs ($117.50 savings/day) 36% lower costs in ACO model ($12,000 saved per patient) (Brumley 2007) (Lustbader 2016) Commercial Health Insurer Program 22% lower medical costs ($12,000 saved per member on program) (Krakauer 2009)

THE 5 KEY CHARACTERISTICS OF EFFECTIVE PALLIATIVE CARE

• Target the highest risk people
• Ask people what matters most to them, and modify

their care accordingly (Advance Health Care Planning)

• Ensure proactive pain/symptom management

(Proactive Medical Management)

• Support family and other caregivers (Proactive

Management)

• Provide 24/7 access

14

GUEST PRESENTER

• Dr. Daniel R Hoefer

CMO Palliative Medicine Sharp Healthcare

SHARP TRANSITIONS PROGRAM: TARGET THE HIGHEST RISK PEOPLE

16

• Experiencing functional decline
• Hospitalization or ED visit due to advanced chronic

illness

• Examples

– CHF NYHA stage 3 or greater – COPD FEV1 <35%; on home oxygen – Dementia FAST 5 score; assistance with IADLs

SHARP TRANSITIONS PROGRAM: HOW IT WORKS

Care Team

RN, MSW, Physician and Spiritual Care Services

Active Phase

4-6 weeks of home visits with patient/family

RN averages 6 visits; MSW 1-2 visits Maintenance Phase

Regular phone communication/coordination, visits as needed; preparing for the future… eventually hand off to hospice

SHARP TRANSITIONS PROGRAM: FOUR PILLARS ENSURE EFFECTIVE CARE

SHARP TRANSITIONS OUTCOMES: HOSPITAL + ED UTILIZATION

SHARP TRANSITIONS OUTCOMES: TOTAL COST OF CARE

Q & A

Questions About the ACLC?

If you have questions about the ACLC please email

members@accountablecarelc.org

801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107