Accountable health care organizations are increasingly recognizing that the care of individuals with serious illness represents a prime opportunity for improvement.
The American Journal of Accountable Care. 2020;8(2):32-33At least 12 million adults and half a million children in the United States are living with a serious illness.1,2 A serious illness is a health condition that carries a high risk of mortality and commonly affects a patient for several years, such as metastatic cancer, heart failure, chronic obstructive pulmonary disease, and dementia.3 As the authors of “Gauging the Experiences of the Seriously Ill in California: Analyzing Serious Illness Beyond Medicare Fee-for Service” have highlighted in the current issue,4 individuals living with a serious illness are the disproportionate users of our health care system: 911 calls, emergency department visits, repeated hospitalizations, and polypharmacy occur 4 to 5 times more frequently in this population. Yet despite high utilization and spending, those with serious illnesses often receive low-value—even distressing—service from our health care system.5,6 In particular:
Fortunately, accountable health care organizations are increasingly recognizing that the care of individuals with a serious illness represents a prime opportunity for improvement. Value-driven providers, accountable care organizations, Medicare Advantage plans, and others are implementing effective strategies that improve quality of life while decreasing costs.
These strategies entail first identifying the population living with serious illnesses early enough to impact the course of their trajectory; the article in this issue provides important insight into a useful identification process. Once the population is identified, clinicians with appropriate training should work to clarify patients’ goals of care and assess both symptom and caregiver burden. Nurse care managers are often best situated to these conversations and can then work with the treating teams to modify care plans accordingly. For those with high levels of need, specialty palliative care teams should consult or comanage the care, including providing home-based care when appropriate.
Together, building early identification processes, training key clinicians in communication and symptom management skills, and ensuring access to specialty palliative care when warranted make a dramatic difference in both the quality and the cost of care for individuals living with a serious illness.12Author Affiliation: Center to Advance Palliative Care, New York, NY.
Source of Funding: None.
Author Disclosures: Ms Silvers has received a grant to educate on serious illness care.
Authorship Information: Concept and design; drafting of the manuscript; and literature/citation review.
Send Correspondence to: Allison Silvers, MBA, Vice President, Payment and Policy, Center to Advance Palliative Care, 55 W 125th St, Ste 1302, New York, NY 10027. Email: email@example.com.REFERENCES
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