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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

Financing and Payment Strategies
to Support High-Quality Care for
People with Serious Illness

PROCEEDINGS OF A WORKSHOP

Laurene Graig, Elaine Soohoo, and Joe Alper, Rapporteurs

Roundtable on Quality Care for People with Serious Illness

Board on Health Care Services

Board on Health Sciences Policy

Health and Medicine Division

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THE NATIONAL ACADEMIES PRESS
Washington, DC
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contract No. HHSN263201200074I (Task Order No. HHSN26300096) with the National Institute of Nursing Research/National Institutes of Health and by Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem, Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Common Practice, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, Hospice and Palliative Nurses Association, The John A. Hartford Foundation, Kaiser Permanente, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Sentara Healthcare, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, Susan G. Komen, UnitedHealth Group, and the National Academy of Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-47444-3
International Standard Book Number-10: 0-309-47444-2
Digital Object Identifier: https://doi.org/10.17226/25071

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Financing and payment strategies to support high-quality care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25071.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

PLANNING COMMITTEE FOR A WORKSHOP ON FINANCING AND PAYMENT STRATEGIES TO SUPPORT HIGH-QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1

MARK B. GANZ (Co-Chair), President and Chief Executive Officer, Cambia Health Solutions

HAIDEN HUSKAMP (Co-Chair), 30th Anniversary Professor of Health Care Policy, Harvard Medical School

ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition

PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield

STEPHEN FRIEDHOFF, Senior Vice President, Clinical Strategy and Programs, Anthem, Inc.

LEE GOLDBERG, Director, Improving End-of-Life Care Project, The Pew Charitable Trusts

ANNA GOSLINE, Senior Director of Health Policy and Strategic Initiatives, Blue Cross Blue Shield of Massachusetts

ZIAD HAYDAR, Senior Vice President and Chief Clinical Officer, Ascension Health

JOANNE LYNN, Director, Center for Elder Care and Advanced Illness, Altarum Institute

JAMES MITTELBERGER, Director and Chief Medical Officer, Optum Center for Palliative and Supportive Care, UnitedHealth Group (through July 2017)

SHARON SCRIBNER PEARCE, Vice President, Policy, National Hospice and Palliative Care Organization

LEONARD D. SCHAEFFER, Judge Robert Maclay Widney Chair and Professor, University of Southern California

ALLISON SILVERS, Vice President for Payment and Policy, Center to Advance Palliative Care

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

Project Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SYLARA MARIE CRUZ, Research Assistant

SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum

ANDREW M. POPE, Director, Board on Health Sciences Policy

Consultant

JOE ALPER, Consulting Writer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1

LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California

JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School

JENNIFER BALLENTINE, Executive Director, California State University Institute for Palliative Care

ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition

AMY J. BERMAN, Senior Program Officer, The John A. Hartford Foundation

PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield

GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses

STEVE CLAUSER, Program Director, Improving Healthcare Systems, Patient-Centered Outcomes Research Institute

JEFF COHN, Medical Director, Common Practice

JANET CORRIGAN, Chief Program Officer, Patient Care Program, Gordon and Betty Moore Foundation

ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts

CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association

STEPHEN FRIEDHOFF, Senior Vice President, Clinical Strategy and Programs, Anthem, Inc.

MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

ZIAD HAYDAR, Senior Vice President and Chief Clinical Officer, Ascension Health

PAMELA S. HINDS, Director of Nursing Research and Quality Outcomes, Children’s National Health System

HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Harvard Medical School

KIMBERLY JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine

CHARLES N. KAHN III, President and Chief Executive Officer, Federation of American Hospitals

REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation

TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care

SHARI M. LING, Deputy Chief Medical Officer, Centers for Medicare & Medicaid Services

BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation

JOANNE LYNN, Director, Center for Elder Care and Advanced Illness, Altarum Institute

DIANE E. MEIER, Director, Center to Advance Palliative Care

AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care

JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, National Institute of Nursing Research, National Institutes of Health

R. SEAN MORRISON, Director, National Palliative Care Research Center

MURALI NAIDU, Vice President, Chief Clinical Officer, Sentara Healthcare

BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society

HAROLD L. PAZ, Executive Vice President and Chief Medical Officer, Aetna Inc.

SHARON SCRIBNER PEARCE, Vice President, Policy, National Hospice and Palliative Care Organization

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

JUDITH R. PERES, Long-Term and Palliative Care Consultant, Clinical Social Worker, and Board Member, Social Work Hospice and Palliative Care Network

PHILLIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute; former Dean, Stanford School of Medicine and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology

WENDY PRINS, Senior Advisor, Quality Innovation, National Quality Forum

THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System

JOANNE REIFSNYDER, Executive Vice President, Clinical Operations and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association

JUDITH A. SALERNO, President, The New York Academy of Medicine

KATRINA M. SCOTT, Oncology Chaplain, Massachusetts General Hospital, representing the Association of Professional Chaplains

KATHERINE SHARPE, Senior Vice President, Patient and Caregiver Support, American Cancer Society

JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society

CHRISTIAN SINCLAIR, Outpatient Palliative Oncology Lead, Division of Palliative Medicine, University of Kansas Health System, representing the American Academy of Hospice and Palliative Medicine

TANYA STEWART, Senior Medical Director, UnitedHealthcare Retiree Solutions

SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente

Roundtable on Quality Care for People with Serious Illness Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SYLARA MARIE CRUZ, Research Assistant

PATRICK BURKE, Financial Associate

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

ELAINE SOOHOO, Christine Mirzayan Science & Technology Policy Graduate Fellow (January–April 2018)

SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum

ANDREW M. POPE, Director, Board on Health Sciences Policy

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

EMILY CHAI, Mount Sinai School of Medicine

JEANNE CHIRICO, Hospice & Palliative Care Association of New York State

TORRIE FIELDS, Blue Shield of California

ROBERT FINE, Baylor Scott and White Health

VICKI JACKSON, Harvard Medical School

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BETTY FERRELL, City of Hope National Medical Center. She was responsible for making certain that an

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs Mark Ganz and Haiden Huskamp for their valuable contributions to the development of this workshop. We also wish to thank all the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. We are extremely grateful to the speakers and moderators, who generously shared their expertise and their time with workshop participants.

Support from the many annual sponsors of the Roundtable on Quality Care for People with Serious Illness is critical to the roundtable’s work. The sponsors include Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem, Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Common Practice, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, Hospice and Palliative Nurses Association, The John A. Hartford Foundation, Kaiser Permanente,

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×

Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Institute of Nursing Research, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Sentara Healthcare, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, Susan G. Komen, UnitedHealth Group, and the National Academy of Medicine.

Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Acronyms and Abbreviations

ACA Patient Protection and Affordable Care Act of 2010
ACO accountable care organization
AQC Alternative Quality Contract
BCBSMA Blue Cross Blue Shield of Massachusetts
BCBSNC Blue Cross Blue Shield of North Carolina
BPCI Bundled Payments for Care Improvement
BSWH Baylor Scott & White Health
CHIP Children’s Health Insurance Program
CHRONIC Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act
CMMI Center for Medicare & Medicaid Innovation
CMS Centers for Medicare & Medicaid Services
COBRA Consolidated Omnibus Budget Reconciliation Act
COPD chronic obstructive pulmonary disease
CPC Plus Comprehensive Primary Care Plus
EHR electronic health record
HEDIS Healthcare Effectiveness Data and Information Set
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
×
I-SNP Institutional Special Needs Plan
IMPACT Improving Medicare Post-Acute Care Transformation Act of 2014
MACRA Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015
NCQA National Committee for Quality Assurance
OECD Organisation for Economic Co-operation and Development
PACE Programs of All-Inclusive Care for the Elderly
PPO preferred provider organization
SNF skilled nursing facility
SNP special needs plan
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25071.
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Millions of people in the United States live with serious illnesses such as cancer, heart disease, chronic obstructive pulmonary disorder (COPD), amyotrophic lateral sclerosis, Parkinson's disease, and dementia—often for many years. Those facing serious illness have a range of interconnected medical and non-medical needs, and the way their care is financed has a large impact on the care they receive. Medicare is the predominant payer, but both Medicaid and private payers also play significant roles in financing care for serious illness. In an effort to address the complex needs of people with serious illness, public and private health care payers are testing innovative financing strategies and alternative payment models. These innovative approaches signal a gradual transition from the traditional-fee-for-service system that pays providers based on the quantity of services to a system based on the value of care provided and a heightened focus on improved quality of care at lower cost.

To explore this evolving financing and payment landscape for serious illness care within public- and private-sector programs, the Roundtable on Quality Care for People with Serious Illness developed a workshop, Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness. The workshop convened clinicians, researchers, policy analysts, and patient advocates, as well as representatives from academia, government and private health care plans, and insurers to discuss challenges and opportunities in financing high-quality care for people with serious illness. This publication summarizes the presentations and discussions from the workshop.

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