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Elder Law Prof Blog
Katherine C. Pearson, Editor, and a Member of the Law Professor Blogs Network on LexBlog.com

New Blog Post on Palliative Care, Health Policy & Health Reform

By rmorgan

A new post published on the Health Affairs Blog on December 23, 2013 was the second installment on the discussion on palliative care, health policy and health reform.  Advanced Care Model Honors Dignity, Integrates Health System for Seriously Ill People and Loved Ones was co-authored by Brad Stuart, Andrew MacPherson and Gary Bacher.  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.

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.” The post notes the disjointed approach that results in patients with “advanced illness” mired in the gap between providers and existing programs. “In short, a person with advanced illness has entered the “gray zone” between treatable and terminal illness.”

The authors describe the “Advanced Care” model as one that operates on what some might describe as a horizontal plane, using “a ‘team of teams'” for coordination of care. The authors list the key components of the model as:

  • Prioritizing personal values, goals, and preferences as drivers of care, rather than clinical urgency and crisis.

  • Placing the focus of care at home, whether personal residence, long-term care, or homeless shelter…. 

  • Extending palliative care, an important component of Advanced Care, into home and community, managing symptoms and suffering and supporting advance care planning over time at the ill person’s own pace, in the safety and comfort of home.

  • Fostering better use of hospice, increasing enrollments and, where appropriate, earlier entry into hospice.

  • Empowering the personal physician to guide a team of critical allied professionals such as nurse practitioners, physician assistants, nurses, social workers and others. This approach mitigates workforce challenges by leveraging scarce geriatrician, palliative care, and primary care physician time and expertise through teamwork….

  • Integrating care across acute, post-acute, and long-term care settings into a coherent, operational whole, preparing disparate hospitals and provider groups to work with private health plans and Medicare to provide accountable care-based solutions….  

  • Preparing for population management….

The authors conclude that this model may provide better care for those patients who have significant chronic illnesses and emphasizes home care over hospital care.

Thanks to Charlie Sabatino, Executive Director of the ABA Commission on Law & Aging for forwarding information about this blog post.