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The Intersection of Compassion and Quality in Healthcare’s Most Challenging Moments

May 29, 2014
3:37 pm

We’ve discussed advanced illness management previously in this space, focusing on the challenges faced by Medicare and healthcare plans and providers in examining both the cumulative costs of care provided to patients in the final months of life while wanting to do what is in the best interest of those patients and their loved ones.

Two Healthcare Leadership Council members provided insights on this issue in a Senate Special Committee on Aging hearing that took place last week.  Executives from Ascension Health, the nation’s largest non-profit hospital system, and Aetna, one of the country’s leading health insurers, shed important light on advances that are taking place to reduce the cost of advanced illness management while generating greater satisfaction among patients and families.

Dan O’Brien, Ascension Health’s Senior Vice President of Ethics, Discernment and Church Relations, discussed Ascension’s system-wide Palliative Care initiative, which has enabled the creation of standardized measures and outcomes as well as demonstrated financial feasibility and sustainability.  Within one year, he said, a 20 percent compliance rate within the Ascension system has grown to an 80 percent compliance rate with the palliative care program.  Palliative care teams have increased the quality of care while reducing costs, reducing length of stay, and increasing patient and family satisfaction.  He noted, however, that palliative care teams still struggle to receive necessary funding and he asked the committee to support appropriate funding for palliative care and advanced care planning.

Dr. Randall Krakauer, the National Medical Director of Medicare for Aetna, told the committee that, in the last month of life among seniors, 80 percent of care is received in an acute care setting, even when it’s not medically appropriate.  Palliative and hospice care, he said, reduces the use of medically unnecessary services and positively impacts beneficiary satisfaction and quality of care.  Aetna launched its Compassionate Care Program to assist plan members in managing their illnesses and has had strong results with the Medicare population, seeing a more than 80 percent reduction in acute days, intensive care days and emergency room use.  Dr. Krakauer testified it would be a positive step for Medicare Advantage beneficiaries to have access to hospice earlier and be able to receive curative treatment while in hospice.

With their testimony, these two organizations made significant contributions to the ongoing conversation and body of knowledge on how to address advanced illness care, making important points about the role of Medicare coverage regulations and funding for palliative care.

Making Medicare Drug Coverage Work

May 16, 2014
1:32 pm

As those who follow the issue know, there was a great deal of activity in the first quarter of this year regarding the Medicare Part D prescription drug benefit.  The Centers for Medicare and Medicaid Services proposed changes to Part D that, in the opinion of the Healthcare Leadership Council and many other organizations, would have significantly altered a program that has been extraordinarily successful in making prescription medicines affordable for millions of beneficiaries.

The reassuring aspect of this episode is that the system worked as it should.  Serious concerns were raised about the proposed regulations when they were made public, and the administration listened.  CMS Administrator Marilyn Tavenner made the decision that the agency would not pursue action this year on some of the more objectionable and controversial aspects of the proposed rule while still moving forward on less problematic improvements.

A side benefit of this episode is that it catalyzed discussion and improved public understanding regarding the Part D program.  On that note, I want to call attention to an online forum created by the organization Center Forward, which is dedicated to moving beyond partisan conflicts and finding common ground solutions for the nation’s major challenges.  Center Forward has published a set of opinion pieces on the issue of changes to Medicare Part D.  I was honored to be asked to participate in this online discussion, along with representatives of the Pharmaceutical Care Management Association, the Lupus Foundation of America and the National Community Pharmacists Association.

I urge you to check out the Center Forward forum.  It’s a multi-faceted discussion on both the pharmaceutical access aspects of Medicare Part D and how they impact patient health, but also how the structure of the program affects pricing and affordability.  As we strive to maintain Part D’s efficacy and high approval ratings, we need more interactions like this one.