In the U.S. today, there are 45 million Americans living with one or more chronic conditions (such as diabetes, heart disease and chronic obstructive pulmonary disease) that are likely to worsen, rather than get better.
Many of these “high-need” individuals are limited in their ability to perform everyday tasks, such as bathing, dressing and walking. This population is also living longer, and as demographics continue to shift toward a higher number of elders living with serious illness, this growth is fueling demand for care where people want it most – in their home and in their community (e.g., local doctor’s office).
In 2016, the Moore Foundation’s Patient Care Program embarked on an investigation to improve the quality of care in the community for high-need, seriously ill patients. Since then, the foundation has invested more than $58 million to improve the experiences and outcomes of care for high-need patients.
The foundation’s high-need patients work focused on two main goals:
- Accountability and payment: Develop ways to measure and report the quality of care provided to people with serious illness in community-based programs, and to incentivize the development of such programs with changes in reimbursement.
- Workforce: Enhance the skills of the current and future workforce to meet the needs of high-need patients in the community, including family caregivers who provide the bulk of frontline services.
Our grantees have been successful in moving the needle in both areas.
The announcement of a new Medicare payment model for the serious illness population is a significant accomplishment in accountability and payment. Under this new payment model, clinicians will receive higher pay if they provide high-quality care to patients with serious illness.
Secretary of the U.S. Department of Health and Human Services Alex Azar specifically highlighted this important milestone when he announced the new Medicare payment model in late April. Secretary Azar said: “[The Physician-Focused Payment Model Technical Advisory Committee] has analyzed a huge number of payment model ideas from physicians who are excited about innovation. Their work, including submissions from … the American Academy of Hospice and Palliative Medicine and the Coalition to Transform Advanced Care, has inspired many significant aspects of the initiative we're announcing today."
Key accomplishments also have been achieved in clinician communications skills training – the ability of doctors to talk with their patients about their preferences and goals for care. With foundation support, VitalTalk, the Center to Advance Palliative Care and Ariadne Labs were able to come together to strengthen their training programs, and now the infrastructure is in place to reach 200,000 clinicians per year, up from initially reaching 20,000 clinicians per year.
Field leaders also came together to develop and disseminate recommendations to strengthen the workforce that provides care in the community for high-need patients. In 2018, the foundation brought together 40 influencers to discuss strengthening the health care workforce, and their recommendations were highlighted in a November 2018 Health Affairs blog, Strengthening the Workforce for People with Serious Illness: Top Priorities from a National Summit. This work was also highlighted in new special editions of the Journal of the American Geriatrics Society and Health Affairs.
The foundation’s work to improve care for high-need patients aims to make high-quality serious illness care the norm rather than the exception like it is today. The hard work and dedication of the Patient Care Program grantees is taking the extraordinary performance of a few providers and health systems and making it the standard performance for every provider and health system in the future. While the foundation’s high-need patients grantmaking is winding down, we anticipate that the portfolio’s impact and lessons learned will continue to resonate in the field of patient care. We are pleased to share the results of the mid-course review we conducted about this grant portfolio and to highlight the important accomplishments to date.