The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute

June 12–14, 2013

Fourth Annual National ACO Summit

Follow us on Twitter at @ACO_LN

and use #ACOsummit.  

Track Six: Engaging Patients in Medical Care

PATIENT ENGAGEMENT IN HEALTHCARE DECISION MAKING

Shannon Brownlee, MS, Senior Vice President, Lown Institute; Former Acting Director Health 

Policy Program, The New America Foundation; Author,

Overtreated: Why Too Much Medicine 

is Making Us Sicker and PoorerGlyn Elwyn, BA, MB, BCH, MSC, FRCGP, PhD, Visiting Professor and Senior Scientist, The 

Dartmouth Center for Health Care Delivery ScienceJudith H. Hibbard, DrPH, Senior Researcher, Health Policy Research Group and Professor 

Emerita, Department of Planning, Public Policy and ManagementL. Gordon Moore, MD, Chief Medical Officer, Treo Solutions LLC; Founder of the Ideal 

Medical PracticesChris Saigal, MD, MPH, Associate Professor and Vice Chair, Director of Health Services 

Research, UCLA Department of Urology, Institute of Urologic Oncology

Track Six: Engaging Patients in Medical Care

PATIENT ENGAGEMENT IN HEALTHCARE DECISION MAKING

Shannon Brownlee, MS, Senior Vice President, Lown Institute; Former Acting Director Health 

Policy Program, The New America Foundation; Author,

Overtreated: Why Too Much Medicine 

is Making Us Sicker and PoorerGlyn Elwyn, BA, MB, BCH, MSC, FRCGP, PhD, Visiting Professor and Senior Scientist, The 

Dartmouth Center for Health Care Delivery ScienceJudith H. Hibbard, DrPH, Senior Researcher, Health Policy Research Group and Professor 

Emerita, Department of Planning, Public Policy and ManagementL. Gordon Moore, MD, Chief Medical Officer, Treo Solutions LLC; Founder of the Ideal 

Medical PracticesChris Saigal, MD, MPH, Associate Professor and Vice Chair, Director of Health Services 

Research, UCLA Department of Urology, Institute of Urologic Oncology

Track Six: Engaging Patients in Medical Care

Palliative Care

Lynn Spragens, MBA, President and Chief Executive Officer, Spragens & AssociatesDorothy Deremo, MSN, RN, MHSA, President and Chief Executive Officer, HOM Cares, 

Hospice of Michigan and @HOMe Support; Former Vice President of Patient Care 

Services/Chief Nursing Officer, Henry Ford Health SystemTimothy G. Ihrig, MD, MA, Medical Director, Palliative Care Services, Iowa Health SystemRobert Sawicki, MD, Senior Vice President of Supportive Care, OSF Healthcare

Lynn Hill Spragens, MBA (moderator)Senior Consultant, Center to Advance Palliative Care (CAPC)www.CAPC.org (Mount Sinai School of Medicine, NY, NY)President, Spragens & Associates, LLCLynn@Lspragens.com (Durham, NC 919-309-4606)

Fourth National ACO SummitWashington, DC

June 14, 2013 10:45 amTrack 6, Panel 2

Palliative Care: Custom Care for the Complex Patient

Goals

6

• Overview of Palliative Care & fit with ACO goals

• Identify trends in Palliative Care that are well aligned with ACO initiatives

• Engage panelists re their program innovations

Characteristics of ACO (Ideal)

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• Risk pool of total healthcare costs & ability to plan proactively for care needs

• Services not tied to billing or silos– Use of internet and telephone help– Team work and shared roles– Consulting specialists can get paid without

“doing procedures”

• Alternative uses of capital for facilities

Health Care Costs Concentrated in Sick Few— Sickest 10 Percent Account for 65 Percent of Expenses

Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.

Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2009

1%5%

10%

50%

65%

22%

50%

97%

$90,061

$40,682

$26,767

$7,978

Annual mean expenditure

Goal: a “reliable system of care”

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• What do patients want?

• What do physicians & other providers want?

• What do administrators & payers want?

Is this a patient-centered system??

Definition of Palliative Care*• Palliative care is specialized medical care for people with

serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness -whatever the diagnosis.

• The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient’s other doctors to provide an extra layer of support.

• Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.

http://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion- research/2011-public-opinion-research-on-palliative-care.pdf

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Where Palliative Care Fits

Custom Care for Complex Patients

• Patients with multiple medical conditions – beyond single disease approaches

• “Whole person” & family; context is very important to helpful interventions

• Patient Values drive choices

• Meeting needs is a team sport

Goal: Alignment & Clarity

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Better health. Better care. Lower cost.

Ad in Politico, 

November 2012

Palliative care sees the  person beyond the 

cancer treatment.

Palliative care treats the  person as well as the 

disease.

It works.

Challenges

• Timing (proactive vs. reactive)• Time & access• Skills• Roles• Need to update goals; things change• Payment alignment wt investment

Service Design Options

17

Trends

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• Home based services

• Hybrids of palliative care and geriatric models

• Concurrent care in specialty areas such as cancer

• Palliative care as medical home

• Telehealth interfaces with patient & family

• Urgent care for cancer, CHF, other – staffed by palliative care NPs

• Generalist skill building & tools

• Payer interest in support (NBGH-CHF-CAPC project)

Keys to Success in ACO

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Results are best when “right patients” are identified proactively and early•Services are broadly and consistently available – system-wide•Critical mass of trained specialty staff + educational outreach to generalists•Use of evidenced based tools•Initiative is paired with good E.H.R. & Advance Care Planning•Clear measurement strategy

Panelists Today• Susan Block, MD (Boston, MA)

Dana Farber, Brigham & Women’s • Dorothy Deremo, MSN, RN, MHSA (MI)

Hospice of Michigan• Timothy Ihrig, MD, MA (Iowa)

Iowa Health System/UnityPoint Health• Robert Sawicki, MD (Illinois)

OSF Healthcare

Initial Questions• What recent results have surprised you?• What screening method to ID patients is working

the best for you?• What are you most excited about going forward?• How have you moved orgs from focus on

advance directives to advance care planning?• Can you share specific results with interested

ACOs?

Thank YouFor more information:http://www.dana-farber.org/Adult-Care/Treatment-and- Support/Treatment-Centers-and-Clinical-Services/Pain-Management- and-Palliative-Care.aspx

http://www.hom.org/?page_id=6773

http://www.trmc.org/palliative-care.aspx

http://www.osfhealthcare.org/supportive-care/

www.capc.org

Track Six: Engaging Patients in Medical Care

Palliative Care

Lynn Spragens, MBA, President and Chief Executive Officer, Spragens

& AssociatesDorothy Deremo, MSN, RN, MHSA, President and Chief Executive Officer, HOM Cares, 

Hospice of Michigan and @HOMe

Support; Former Vice President of Patient Care 

Services/Chief Nursing Officer, Henry Ford Health SystemTimothy G. Ihrig, MD, MA, Medical Director, Palliative Care Services, Iowa Health SystemRobert Sawicki, MD, Senior Vice President of Supportive Care, OSF Healthcare

The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute

June 12–14, 2013

Fourth Annual National ACO Summit

Follow us on Twitter at @ACO_LN

and use #ACOsummit.