leonard d. schaeffer: "can our health care system provide a ‘good death’?" 9.29.16

Leonard D. Schaeffer Judge Robert Maclay Widney Chair and Professor, University of Southern California

September 29, 2016

Health Matters Webinar: Can Our Health Care System Provide a “Good Death”?

2 LDS 2016 All Rights Reserved

•  In last century, death has evolved from a family event to a medical event

•  Many die in circumstances that do not reflect their values or preferences

•  A more culturally diverse population means clinicians cannot make assumptions about the care choices patients might make

•  A fragmented care delivery system with perverse financial incentives contributes to uncoordinated care and unnecessary costs

Dying in America (DIA): Why Improve End-of-Life Care?


1.  Delivery of person-centered, family-oriented care

2.  Clinician-patient communication and advance care planning

3.  Professional education and development

4.  Policies and payment systems

5.  Public education and engagement

DIA Recommends Change in 5 Key Areas to Transform End-of-Life Care


What Does DIA Recommend?

1. Delivery of person-centered, family-oriented care

•  Health care delivery organizations should provide integrated, person-centered, family-oriented and consistently accessible care near end of life

•  Government and private health insurers should cover and pay for these services

•  Care should be transparent and accountable through public reporting of quality and costs


•  The advance care planning process should center on frequent conversations with patients, family members and providers and should be electronically stored

•  Professional societies and other organizations should develop standards for clinician–patient communication and advance care planning

•  Payers and health care delivery organizations should adopt these standards


2. Clinician-Patient Communication and Advance Care Planning


•  Educational institutions, professional societies, accrediting organizations, certifying bodies, health care delivery organizations and medical centers should:

Ø  Establish training, certification, and/or licensure requirements for palliative care knowledge/skills

Ø  Increase the number of palliative care specialists

Ø  Expand the knowledge base for all clinicians


3. Professional Education & Development

•  Payment systems should undergo a major reorientation to incentivize: Ø  Integration of medical and social services

Ø  Coordination of care across multiple care settings

Ø  Use of advance care planning and shared decision making

•  Congress should enact legislative changes if necessary

•  Federal government should require public reporting on quality measures, outcomes, and costs of care near end of life for its programs


4. Policies & Payment Systems

7


•  Public education and engagement about end-of-life care planning is needed at the societal, community and family, and individual levels

•  A range of organizations should engage constituents and provide fact-based information about care to encourage advance care planning and informed choice

•  Disseminating accurate information is critical to ensure individual care decisions are based on fact


5. Public Education & Engagement

If DIA Recommendations Were Implemented: What Would End-of-Life Care Look Like?

Patients Respected

•  Medical and social services would reflect patients’ values, goals, preferences and condition, and allow for their needs and service intensity to change over time

Crises Prevented

•  Comprehensive, person-centered and family-oriented care would reduce preventable crises, repeated 911 calls, ER visits, and hospital admissions

Costs Stabilized

•  High-quality patient-centered care could help stabilize aggregate societal expenditures for medical and social services, and potentially lowers their costs

9


ü  Public is way ahead of policymakers, health care organizations and the media on this issue…

ü  Many Americans have had a difficult experience with the final days of a family member or dear friend…

ü  Dying in America report captures the human interest and the data, and provides a roadmap for change…

A movement to change how we die is underway: journalists can educate the public about policy & personal

options to help accelerate cultural and systemic change

Opportunity for Journalists: Everybody Has a Story

leonard d. schaeffer: "can our health care system provide a ‘good death’?" 9.29.16

Healthcare