April 27, 2022

Emerging Policy Opportunities for Community-Based Serious Illness Care

The pandemic has accelerated trends moving the delivery of care into the home or community. Yet, care at home largely remains the province of better resourced individuals, due to limited funding by government programs. Medicaid, the federal/state program of health care for people of lower income, has the potential to address these equity issues through waivers or plan amendments.

With little fanfare, States have been innovating new models of care within their Medicaid programs, such as community-based palliative care, to support people with serious illness and improve health equity. For example, California initiated the trend, and Hawaii has a multi-year effort to implement improved benefits for people with serious illness. Several states are actively working on a similar approach, and others have expressed interest.

This Conference explored the opportunities for states to bring a broad range of palliative care services to seriously ill persons, particularly through changes to their Medicaid programs. We hosted experts engaged in this effort, including state and federal officials, about the progress to date, key learnings and prognosis for success.

Agenda

The Big Picture: Why Medicaid?

Goals: Statement of the opportunity, the unmet need, the unwanted services, and how to redirect resources

  • Aditi Mallick, MD, Chief Medical Officer, Medicaid and CHIP, Center for Medicare and Medicaid Services (CMS)
  • Zirui Song, MD, PhD, Associate Professor of Health Care Policy, Harvard Medical School (Moderator)
  • Hope Glassberg,  Decipher Health Strategies (Federal Medicaid policy expert)
  • Wendy Fox-Grage, Project Director, NASHP
  • Anastasia Dodson, Division Admin, State of California Dept of Healthcare Services

Exploring Key Issues that Must be Addressed

Goals: Goals: Equity, Quality of care, Quality of Life, Reduction of Suffering, Reduction of Overutilization & Avoidable Spending, Defining the population, Defining the benefit, Qualifying providers, Setting reimbursement, Monitoring and Outcomes

  • Torrie Fields, Votive Health (benefit design, payment and policy expert) (Moderator)
  • Elrycc Berkman, Senior Manager Optumas
  • Dr. Rae Seitz, Hui Pohala, and Kokua Mau (palliative care physician and industry leader)
  • Allison Silvers, Center to Advance Palliative Care
  • Kathleen Kerr, ransforming Care Partners (palliative care performance and outcomes expert)