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Narrative Agenda: Financing End-of-Life Care: Challenges for an Aging Population

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An Invitational Meeting Sponsored by The Robert Wood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) initiative and Last Acts Campaign; Conducted by AcademyHealth and Last Acts Campaign
February 6, 2002 - Loews L'Enfant Plaza, Washington, D.C.

8:30 - 9:00 a.m.
Registration and Continental Breakfast

9:00 - 9:15 a.m.
Welcome and Purpose of Meeting

Presenters:
Steven A. Schroeder, M.D.
President & CEO
The Robert Wood Johnson Foundation

Anne K. Gauthier
Director, HCFO Initiative
AcademyHealth

Karen O. Kaplan, Sc.D.
Director, Last Acts Campaign
Partnership for Caring, Inc.

9:15 - 10:15 a.m.
Setting the Context: What Do We Know About End-of- Life Care?

Moderator: Joan Teno, MD, Assistant Professor, Center for Gerontology and Health Care Research
Brown University

Presenter:
Linda Emanuel, MD, Ph.D.
(Paper/Synthesis) Director, Buehler Center on Aging
Northwestern University

This session is intended to set the context for the remainder of the meeting, highlighting what is known; who is involved in end-of-life decisions; what these decisions cost; when end-of-life care services should be accessed; where patients die; and why there is a need for reform in end-of-life policies. It will address the various definitions of end-of-life, the demographics involved and issues surrounding recent changes in clinical trajectory for chronic and terminal conditions.

10:15 - 10:30 a.m.
Break

10:30 a.m. - 12:00 p.m.
The Role of Public Financing of End-of-Life Care

Moderator: Joel Cantor, Sc.D., Director, Center for State Health Policy, Rutgers University

Medicare Presenter:
Marilyn Moon, Ph.D.
(Paper) Senior Fellow
The Urban Institute

Medicare Reactor:
Gail R. Wilensky, Ph.D.
John M. Olin Senior Fellow
Project HOPE

Medicaid Presenter:
Joshua M. Wiener, Ph.D.
(Paper) Principal Research Associate
The Urban Institute

Medicaid Reactor:
Karen I. Squarrell Shablin
Associate Vice President
National Strategy for AmeriHealth Mercy Health Plan

This session will discuss the role of the Medicare and Medicaid programs in financing end-of-life care. In particular, it will address the structure and limitations of the Medicare and Medicaid hospice benefits and what is known about why people choose to take advantage of these benefits and why they do not. It also will address the regulatory barriers to financing and access to end-of-life care and the challenges created by varying regulatory interpretations. The "costs" inherent in end-of life care choices, in terms of financial burden, administrative burden, futile care, utilization, and impact on the quality of care obtained will also be discussed.

The session will focus on key financing questions, including how the source/type of financing affects utilization and quality; how coverage type (FFS, MC) affects financing of care delivery; and whether current reimbursement rates are adequate. The impact of these rates on utilization, quality, and the financial stability of providers will also be addressed.

12:00 - 1:00 p.m.
Lunch

1:00 - 2:30 p.m.
Innovative Models of Organization and Delivery of End-of-Life Care

Moderator: Karen O. Kaplan, Sc.D., Director, Last Acts Campaign, Partnership for Caring, Inc.

Presenter:
Joanne Lynn, MD
(Paper) Director, Center to Improve Care
of the Dying
RAND

Panelists:
Charles Butler
Vice-President-Government and Public Relations
Blue Cross and Blue Shield of Montana

J. Donald Schumacher, Psy.D.
President & CEO
Center for Hospice and Palliative Care

Karen A. Armacost
Directory
Hopkins ElderPlus

This session will highlight innovative models for the organization and delivery of end-of-life care and provide "front-line" perspectives on how it may be financed. The discussion will address the ways in which health plans are working to develop end-of-life benefits, particularly for covered retirees. In addition, the session will consider the implications of the aging baby boom population and the increasing need for greater focus on "quality of death" for appropriate modes of end-of-life care.

2:30 - 2:45 p.m.
Break

2:45 - 4:00 p.m.
Mainstreaming the Message: What Do Decision Makers Want and Need to Know about End-of-Life Financing and Organization?

Moderator: Steven A. Schroeder, MD, President & CEO, The Robert Wood Johnson Foundation

Panelists:
William J. Scanlon, Ph.D.
Director, Health Financing and Systems
U.S. General Accounting Office

William D. Novelli
Executive Director & CEO
AARP

Samuel W. Warburton, MD
Corporate Medical Director
Aetna

Carolyn J. Cassin
Administrator
Michigan Department of
Community Health

This session will draw together the day's discussions and attempt to identify areas in which public policy has a role in developing creative efforts to improve care at the end-of-life. This will include a discussion of what public and private decision makers need to know about this critical time, including where there are gaps in what we know and research needs. The presenters will address policy options for meeting the cost, access, and quality goals of end-of-life care. Questions to be addressed include:

What issues should be targeted by public policy and what are the goals, e.g., access barriers, family burden, palliative strategies, high-cost hospice cases, etc.?
How should geographic variation in the use of health care services and cultural preferences/barriers be addressed relative to end-of-life decisions?

4:00-4:15 p.m.
Concluding Remarks

Presenter:
David C. Colby, Ph.D.
Senior Program Officer
The Robert Wood Johnson Foundation
 
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