1. Palliative care is about the relief of suffering. This requires a multifaceted approach and is something that case management-based or disease management-based programs do not address.
2. Palliative care clinicians are uniquely situated to comment on and participate in healthcare transformation. We need to be advocates and “rabble rousers” (per Dr. Martha Twaddle) to encourage our healthcare system to embrace a focus on prevention and well-being, not only on disease.
3. Dr. Diane Meier stated that we need to start looking at the patient as the “sun,” not the healthcare system; and that we as healthcare providers and systems of care need to orbit around our patients to truly deliver person-centered care.
4. Dr. Martha Twaddle noted that in the U.S. we don’t spend more on healthcare but rather on the healthcare industry (e.g., hospitals, big pharma, and administration of healthcare). The healthcare industry is likened to a cruise ship that just keeps getting bigger and bigger, while our health outcomes are not improving at the same rate.
5. Social determinants of health (e.g., ability to meet daily needs of healthy food and safe environment, access to health care and education, access to economic opportunities) are incredibly influential on the health of a community. We cannot ignore these issues in palliative care. We need to be part of the broader conversation to improve overall access to care, resources and opportunity for everyone in this country. These issues impact our patients’ and caregivers’ ability to achieve wellness and healing.
6. Community-based palliative care is where the focus needs to be in the next 10 years.
7. Payment for community-based palliative care is difficult, but there are many creative ways to explore these issues, including partnering with ACOs, developing payer contracts with Medicare Advantage plans, grants, philanthropy, etc.
8. Telehealth is now entering the mainstream. The definition of telehealth is wide and includes synchronous (e.g., videoconferencing) and asynchronous (e.g., text, portals, apps) methods. These can be helpful to improve access to care and experience of care.
9. Every program needs to be measuring something, and many programs find this challenging with barriers of complex EMRs, lack of time and resources. Start small, but START. Piloting can be helpful to show the impact of programs to potential payer sources.
10. It’s important to remember that everyone has a story, including hospital administrators, insurance CEOs, and CMS administrators. We saw this at CAPC as leaders in different sectors of healthcare shared their personal stories of loss of a loved one or a dear patient, and how this has impacted their outlook on hospice and palliative care. We all have a stake in good care for the seriously ill. It could be our mother next…it could be us. Tell the story, focus on the impact on the patient and family. People will connect with these stories in a personal way. This will help drive access to the type of care we know will make a difference for people with serious illness.
Bonus Take Home: We in the hospice and palliative care world need to lead the charge in shifting from the “Triple Aim” (improving the health of population, improving patient experience and outcomes and reducing cost of care) to the “Quadruple Aim” which includes an acknowledgement that the care of the patient also requires the care and satisfaction of the clinicians tending to these patients. In fact, our very ability to achieve the triple aim is threatened by high rates of burnout in our physicians and other healthcare providers. Recognition of burnout and self-care are integral components of effective palliative care, and we can be part of the broader conversation to improve the “health” in our healthcare system for ourselves and our patients.