Palliative Care and Pain Management: “Special Generalists”

Posted on | January 30, 2014 | Comments Off on Palliative Care and Pain Management: “Special Generalists”

Mike Magee

Yesterday I had the privilege to spend the day in Washington, DC, with many of the nation’s leaders and experts in the delivery of Palliative Care and Pain Management. The meeting (The State of Palliative Care Across Settings: What Can We Do Together?) was organized by Myra Christopher and John Carney from the Center of Practical Bioethics, and included Senator Mark Warner, Senator Johnny Isakson, Kathy Greenlee (Ass’t Secretary for Aging), Patricia Grady (NIH/NIHR), Suzanne Bosstick and Carol Bradford (CMS Medicare and Medicaid), Edo Banach (CMS Innovation Project), and the remarkable Peggy Battin, Professor of Philosophy from the University of Utah School of Medicine. The discussions were guided by expert moderators including John and Myra, as well as Charlie Sabatino and Richard Payne.

The room at One Washington Circle was filled to capacity with 80 “by invitation” veterans in the field. But in spite of the crowding, there was no stuffiness to the proceedings. Rather, they were electric. Why? Because there was a shared sense of mission and opportunity – the sense that health delivery transformation was “in motion”.

In my brief remarks to the group, I stated that if given the choice that they be “specialists trapped in generalist bodies” vs. “generalists trapped in specialist bodies”, I would much prefer them to be the former. By this I meant that, while I recognized their special knowledge and expertise in the delivery of integrative, team-based health planning and care (primarily for the senior segment of our population), I felt their greatest contribution lay ahead as the generalist leaders of a new and comprehensive approach to health and human potential that could positively impact all Americans.

The full day’s deliberations will be posted shortly on Youtube by John and Myra, and I recommend it highly to you. I will post it in a future link. But for now, I wanted to share with you 10 questions that I posed to my colleagues without answers. Specifically I was asked to summarize the importance of new technologies to the future evolution of palliative care and health delivery reform. I stated that the impact of the Internet and information technology went far beyond provider record keeping or fancy home-based gadgetry. Rather the true and far-reaching disruptive power of IT was it’s impact on “connectivity”.

Connectivity, I said, had the power to:

1. Re-center the power loop of healthcare from “hospital-medical office-hospital” to “home-care team-home”.

2. Efficiently and affordably establish data driven, customized and individualized health planning and coaching in real-time, with 24/7 coverage, with special targeting for at-risk populations.

3. Use algorithms and existing online Cloud data sources to create and populate a consumer controlled Lifespan Planning Record for all Americans, whether they have been just conceived or are in the final phase of their life.

4. Eliminate the “translation gaps” that exist between research finding, clinician practice, and consumer adherence in management of individual and population chronic disease burden.

5. So effectively and efficiently manage health and human potential as to relieve the pressing financial burden of universal coverage; engage individuals, families and communities in the responsible work of maintaining their own health and expanding human potential; and reinforce a comprehensive and holistic philosophy of humanistic care that serves body, mind, and spirit.

The danger, I said, was “under-visioning”, not “over-visioning”. These experts, and the thousands of like-minded caring professionals they represent had already gained access into Americans homes – a singular honor and privilege extended to few. The challenge however, once inside the hearts and minds (and homes) of these fellow citizens is how to leave a lasting positive impact, not only on them, but also on their multi-generational families. Because – yes, they are specialists – but more importantly, they, and their approach to health planning and delivery, is the correct model for all Americans, not simple seniors with a high chronic burden of disease.

So, thinking about “connectivity” strategically, I suggested they answer for themselves, in their own communities, these 10 questions:

1. What do I wish to connect?

2. Who do I wish to connect to?

3. For what purpose am I making these connections?

4. Who visits whom, where and when in my vision?

5. Can more than 1 family member get services when I’m in the home/neighborhood?

6. Who is on my team?

7. Does my team include the patient, and the family caregiver?

8. Do all of my team members have new (modern) job descriptions – including the patient, the family caregiver and the physician?

9. Do my patent, and all of her/his multi-generational family members have a Lifespan Plan – and are we using the same hardware and software on an appropriate mobile device designed for navigation by users ages 3 to 100?

10. How do I work with government and private insurers to secure reimbursement to allow steps 1 through 9 to be actualized?

Great people! Great day! Great potential!

For Health Commentary, I’m Mike Magee.