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Improving Care and Outcomes for Patients with Advanced Illnesses and their Caregivers- Policy and Practice Implications Bill Novelli Professor, McDonough School of Business, Georgetown University Co-Chair, Coalition to Transform Advanced Care


  1. Improving Care and Outcomes for Patients with Advanced Illnesses and their Caregivers- Policy and Practice Implications Bill Novelli Professor, McDonough School of Business, Georgetown University Co-Chair, Coalition to Transform Advanced Care (C-TAC) Co-Chair, Care Culture and Decision-Making Innovation Collaborative (National Academy of Medicine) November 1, 2018 #PCORI2018

  2. Bill Novelli, Co-Chair, Coalition to Transform Advanced Care • Disclosure: C-TAC has received three funding awards from PCORI 2 • November 27, 2018

  3. The Big P icture • We are making progress on the policy and practice front • Much is happening on both the federal and state level • We need more/better evidence to expand access to palliative/advanced illness care 3 • November 27, 2018

  4. The Coalition to T ransform A dvanced Care (C-TAC) C-TAC's Goal: All Americans with advanced illness receive comprehensive, high-quality, person-centered care that is consistent with their goals and values, and honors their dignity. • Policy and Advocacy • Family care-giver support • State and Community Coalitions • Advanced Care Transformation Index • Respecting Choices • National Summit on Advanced Illness Care 4 • November 27, 2018

  5. Federal Policy Progress • Passed legislation • CHRONIC Care Act (Balanced Budget Act) to extend Independence at Home demonstration, allow Medicare Advantage supplemental benefits, expand use of telehealth • RAISE Family caregiver Act to develop national family caregiver strategy • Finalized regulation • Allow Medicare Advantage supplemental benefits such as home-based palliative care, transportation, and nutrition services • Exclude palliative care population from Part D Opioid Overutilization program • Alternate payment models • C-TAC and AAHPM models approved by PTAC for “urgent testing” • HHS Sec. Azar confirmed they are a priority • CMMI to soon announce own home-based palliative care demonstration 5 • November 27, 2018

  6. Health Plan/Payer Activity • Multi-payer group : CAPC and C-TAC recently sponsored meeting of 20+ health plans offering, piloting or considering palliative care services/benefits • California : Blue Shield now offers home-based palliative care as standard benefit and managed Medicaid plans have to also offer due to recent legislation • Pilots in other states with other payers 6 • November 27, 2018

  7. State Coalitions • California Coalition for Compassionate Care - Recent legislation to require managed-Medicaid to offer palliative care • Massachusetts Coalition for Serious Illness Care - Surveyed state on advanced directives attitudes, leveraging Gawande’s Serious Illness Conversation tools • Oregon - Cambia funding needs assessment and developing messaging to promote serious illness care • Other state coalitions in various stages of development 7 • November 27, 2018

  8. PCORI Research • Investing in studies on advance care planning, including one using C-TAC’s Respecting Choices First Steps materials • Other studies will test advanced illness and/or palliative care models to see which are most effective • Need more/strong evidence to persuade health system, policy, payer stakeholders to offer these programs/benefits 8 • November 27, 2018

  9. The Blue Chair and Driving Miss Norma 9 • November 27, 2018

  10. Learn More • www.pcori.org • info@pcori.org • #PCORI2018 • C-TAC Homepage: www.thectac.org • National Summit Page: www.ctacsummit.org 10 • November 27, 2018

  11. Thank You! Bill Novelli Professor, McDonough School of Business, Georgetown University Co-Chair, Coalition to Transform Advanced Care (C-TAC) Co-Chair, Care Culture and Decision-Making Innovation Collaborative (National Academy of Medicine) November 1, 2018 11 • November 27, 2018

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