An Interview with Jay Bhatt, DO: The Essential Role of Palliative Care in Health Care Today

This blog post is part of a five-part series, in which Diane E. Meier, MD, interviews the inspiring keynote speakers of CAPC National Seminar 2018.

In this post, Dr. Meier is joined by Jay Bhatt, DO, senior vice president and chief medical officer of the American Hospital Association (AHA). This interview provide a sneak peek into Dr. Bhatt’s keynote, ‘Palliative Care as an Essential Population Health Strategy for Today’s Health System.’

Dr. Diane E. Meier (DEM): Thank you for agreeing to give a plenary at our upcoming CAPC Seminar and for participating in this interview. I’d like to begin by asking you to describe the work that AHA is undertaking, to help prepare members for the transformation to value in the United States.

Dr. Jay Bhatt (JB): Thank you for this opportunity. The AHA has been on a journey to help the field redefine the role of the hospital and health system for communities. We know that there are real systemic pressures on care delivery, especially when it comes to affordability, leaving more patients with the need to go out of pocket for care than ever before, and causing hospital and health system leaders to evolve and reimagine business models. The AHA is committed to helping its members improve affordability and deliver on their mission to serve their communities.

The AHA released a strategy in early 2017 titled The Path Forward: Advancing Health in America, anchored around the vision of a society composed of healthy communities where each individual reaches their highest potential for health. It is made up of five commitments to improving access, value, partners, well-being, and coordination, as a way to track progress on that vision. We know that 50 percent of medical expenses are driven by the needs of only 5 percent of our population, and evolving delivery models must address the unique needs of the most seriously ill. At the end of the day, our mission is to help patients and caregivers achieve what matters most to them.

DEM: In that regard, I’ve been watching the launch of the Age-Friendly Health Systems project, an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), which is in partnership with the AHA and the Catholic Health Association of the United States (CHA). We are hoping to integrate the work that CAPC is doing with the AHA, as an integral part of this initiative.

JB: Absolutely. We’re excited to be working with the John A. Hartford Foundation, IHI, and CHA—as well as five pilot systems: Anne Arundel Medical Center (AAMC), Ascension, Kaiser Permanente (KP), Providence St. Joseph Health, and Trinity Health.

The number of older adults is projected to double over the next twenty-five years. Among this group, 80 percent have at least one chronic disease, and 77 percent have at least two. We’ve built a system that’s well-equipped for acute care, but not well-matched to the management of chronic disease over a long period of time. Becoming an age-friendly health system entails reliably providing a set of specific evidence-based best practices in a manner that clinicians can implement. This can potentially lead to better outcomes—reduced variation and increased utilization of high value services for older adults.

• What Matters: Know and act on each older adult’s specific health care goals and care preferences across settings.
• Medication: If medications are necessary, use age-friendly medications that do not interfere with what matters, mentation, or mobility—while thinking about adverse events and trying to avoid them.
• Mentation: Identify, treat, and manage dementia, depression, and delirium across care settings.
• Mobility: Ensure that older adults move safely every day, in order to maintain function, and do activities that matter to them.

These are the core elements of high-quality care for older adults, and those with advanced and serious illness. We completed our pilot programs with promising results. For example, AAMC has estimated that by avoiding unnecessary and preventable hospital stays and other utilization, ten years of time has been given back to their patients, to do the things that are important to them.

DEM: That’s great. Many of those goals are identical to those that palliative care teams have advanced, on behalf of patients and families across the continuum, including most importantly, determining what matters most to the patient and family before doing anything else. And then developing and designing a care plan that is responsive, and honors the things that matter to the patients who we are trying to serve, as well as the people who love and care for them. There’s obvious overlap and alignment.

You may be aware that more than 94 percent of hospitals with 300 beds or more report already having a palliative care team. If you include all hospitals with more than fifty beds, we’re now up to 80 percent. This shows that hospitals are already voting with their feet, and in very striking numbers, investing in this capacity on behalf of their patient population. In your leadership role at the AHA, do you now view palliative care as a ‘nice to have’ or a ‘must have’ for a modern hospital in the United States?

JB: Thank you for sharing those statistics. I think it’s very encouraging to see hospitals and health systems embrace palliative care as a way to help patients and families across the continuum and age spectrum achieve optimum health where they are. Palliative care is a ‘must have’ for modern hospitals. There is not a meeting that I go to, or conversation that I have related to care delivery, quality, and population health where I don’t hear of the desire for help in getting better at advanced illness and palliative care.

I saw this trend early on in my career while training at Michigan Medicine and the Ann Arbor VA and in the VA and still today as I travel across the country in my role at the AHA. We’ve had a number of conversations as part of our work on The Value Initiative on how palliative care is helping the field manage the challenge of quality and affordability. Specific actions and interventions that we can take to systematically address the issue of serious illness and palliative care is consistently raised during these talks. It’s encouraging to see organizations not only developing programs within the four walls of the hospital, but also working on ambulatory and home based palliative care practices in the community.

I’m excited about the future, as AHA’s work with CAPC helps us continue the steady drumbeat about the need for access to quality palliative care and provide practical, actionable tools and resources to the US health system to support this important work.

DEM: What I think I’m hearing you say is that palliative care is top of mind, and clearly on the radar of people who are looking at local organizational and regional health system transformation. Is that correct?

JB: Yes, it’s on their radar. The challenge is that while we have nearly five thousand hospital and health system members, representing two million nurses and two hundred seventy thousand physicians, there’s a spectrum of where people are in their journey towards value. Palliative care is part of integrated thinking about population health, performance improvement, diffusion of proven innovation, and workforce capacity. There are certain things that all organizations should be able to do; based on stages of development and current needs, resources are available to help each organization move from one stage to the next.

DEM: That’s really helpful to hear. It’s remarkable, having been in this field now for almost twenty-five years, to have gone from something that no one has ever heard of, which barely existed, to something that at least in hospitals, has become standard of care, in a couple of decades. I’m glad that I’ve lived long enough to see it.

JB: It’s amazing. Because of the leadership from people working in palliative care, who have shaped the conversations, advanced new ideas and fresh approaches, and given other health care professionals a vision to work towards, the field is in a better position to act upon the principles of keeping people, families, and communities at the center of our work.

DEM: Yes, exactly. My last question has to do with specific examples of ways that, through partnership, news, technical assistance, training resources, and best practices—things that will avoid reinvention of the wheel by your members—can be disseminated and communicated effectively to your members. How does the AHA typically do this?

JB: I think it is critical to have a multi-pronged approach. To start, this means creating a national community of practice, which CAPC has been able to do, and activating it in the field; AHA will help do this through our members. We can use technical assistance playbooks that create developmentally stratified and contextual approaches to this work, given where organizations are in their journey.

Additionally, the AHA provides multimedia guidance to explain how social media and other technologies such as telehealth can amplify and accelerate this work, as well as encouraging the uptake of tools, resources, and education through virtual expeditions around focused issues like palliative care and serious illness. We aim to make it easier for leadership and trustees in governance to prioritize conversations with each other and their teams on these essential issues.

We’ve done work through the Hospital Improvement Innovation Network (HIIN) and the Age-Friendly Health System that we can share, for instance, Huddle for Care is an online peer community that shares leading practices on transitions of care focused on older adults and those with serious and complex illness.

We’re excited to think about continuing this conversation through our multiple national convening events, such as our rural meeting, policy meeting, and Leadership Summit, as well as executive forums on affordability through The Value Initiative. These initiatives allow us to highlight the compelling case for this work that we will build with CAPC in the foreseeable future.

DEM: That’s very exciting; it sounds like there are multiple platforms and vehicles for essentially a “no wrong door” for access to tools, technical assistance training, and support for palliative care. For CAPC’s members and for hospital and health system palliative care program leads, it will help enormously to have the AHA signaling the importance of palliative care to C-suites and other leadership in hospitals and health systems; it can only help to ensure alignment and commitment to this work. Before we close, do you have any additional thoughts for CAPC members?

JB: Yes—I’d like to start off by saying thank you for doing the incredible work that you do every day across the country. We’re very excited about the opportunity to work with CAPC and all of you on these important focus areas. The nation’s hospitals and health systems are poised to make a difference in the care of our patients living with a serious illness through a commitment to providing better access to quality palliative care. I look forward to having the conversation with all of you and learning more about the ways that AHA can be a partner—and an agent for change—with this community of practice and learners.