Ep 32 – Achieving the Triple Aim with Advanced Care Planning, with Dr. Stephen Bekanich

What this episode covers

Our health care industry excels at rescue care – when a patient needs to be saved, our system has answers. However, we are not well suited to address the challenges associated with serious illness, death and dying. Evidence shows that palliative care and advanced care planning improve health value. These tools lead to better management of pain and symptoms and improve both the quality and length of life. The preferences of patients and their families and caregivers are better accounted for, and their satisfaction is much higher. Healthcare utilization is reduced and outcomes are improved. ACOs that have successfully implemented a palliative care program have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits. So why do only 10% of ACOs have palliative care as one of their foremost strategies? Our guest this week is Stephen J. Bekanich, M.D., the co-founder and Chief Medical Officer of Iris Healthcare, a disease-specific advance care planning service. Prior to this he served as the CEO of Ascension Health’s Texas ACO (with 2,500 physicians and shared savings across government and commercial contracts), as well as the Chief Medical Officer of the health insurance joint venture between Cigna and Ascension Health. Before moving to Austin, he held the rank of Associate Professor of Medicine at the University of Miami Miller School of Medicine and the University of Utah’s Medical Center where he started and directed their palliative medicine programs. Episode Bookmarks:  05:00 A journey in health value that is heartfelt and deeply personal, as it is associated with a personal tragedy 06:45 The loss of grandparents to serious illness and the call to change medical specialization to palliative care 07:21 “The era of antibiotics and airbags” – people no longer dying from infections and trauma like they did historically 08:10 Serious illnesses (COPD, Dementia, late stage malignancies, CHF, etc.) have become the new killer in an evolved society 08:31 Society is not prepared to deal with serious illness and the inevitability of death 10:30 “It is incumbent upon us to get people better prepared for what they will be facing. Almost 85% of us will face serious illness, yet healthcare literacy skills are so low. Something is clearly wrong.” 11:00 Research showing 70-80% of people with incurable cancer believing they will be cured is a failure of physicians to appropriately set expectations. 12:30 Stephen’s shares the personal story of his grandmother’s terminal illness and the difficulty of confronting death 14:00 Palliative care as a force for value and the appointment of a palliative care expert to lead CMMI (Brad Smith) 15:00 “Over the past five to ten years, a number of studies have repeatedly demonstrated how advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.” (Brad Smith) 16:00 Algorithms in population health incorrectly focus on last 6-12 months of life instead of providing a pathway to earlier intervention with Advanced Care Planning (ACP) 17:20 “In the last year of life, we are often delivering care that is unwanted, unnecessary, or nonbeneficial. That is not a good experience for patients and their loved ones.” 17:45 Patients with high symptom burden and in distress cannot focus in discussions about setting goals in care. 19:00 A calm environment prior to serious illness onset results in a better ACP conversation (better for patients). 19:30 Nonbeneficial care starts to occur in the last 12-15 months of life as a second reason to move interventions upstream (better for ACO bottom line)