Project on Advanced Care and Health Policy
Launched in March 2016, the Project on Advanced Care and Health Policy seeks to study and foster development of improved models of care for individuals with serious advanced illness nearing end-of-life, and to apply interdisciplinary analysis to important health law and policy issues raised by the adoption of new person-centered approaches to care for this growing population. It includes a Senior Fellowship, public symposia and events, and policy and research projects.
The Project is a collaboration between the Petrie-Flom Center and the Coalition to Transform Advanced Care (C-TAC), a non-partisan, non-profit alliance of over 130 national organizations dedicated to being a catalyst to change the health delivery system, empower consumers, enhance provider capacity and improve public and private policies in advanced illness care.
Most Americans eventually will face advanced illness, which occurs when one or more conditions become serious enough that general health and functioning decline, treatment begins to lose its effect, and quality of life increasingly becomes the focus of care – a process that can take months or years and continues to the end of life. People with advanced illness are at higher risk for unnecessary hospitalizations, unwanted treatment, adverse drug reactions, and conflicting medical advice. They confront a system that is fragmented, uncoordinated, and poorly equipped to provide the care they need, leaving them to fend for themselves. The current system also results in high healthcare costs for families and our country, which now spends over 25% of all Medicare dollars for care during the last year of life.
In June 2015, C-TAC issued the Advanced Care Report, which describes a framework for an advanced care model based upon evidence-based best practices. Under the advanced care model, personal values drive treatment decisions, a customized blend of palliative and curative care can be provided, care management through interdisciplinary teams coordinates care and provides support across settings, and the focus of care typically moves from the hospital to the home and community. The advanced care model provides a bridge from fee-for-service to valued-based payment and population health.
Current health care law policy and regulation, developed largely in a fee-for-service environment with siloed providers, creates barriers that may impede widespread adoption of improved models of care for those with advanced illness. This creates multiple opportunities for the Project on Advanced Care and Health Policy to drive improvement.
The role of the Senior Fellow is to advance the work of the Project, develop a policy/research agenda for the Project, plan symposia and panel discussions, and be available as a resource for interested members of the Harvard community.
Mark Sterling, JD, is the Project’s inaugural Senior Fellow in Advanced Care and Health Policy. For over 35 years, Mark has been an advisor to mission-driven healthcare organizations. His experience includes serving as partner in a leading global law firm, as general counsel and chief strategy officer of a leading health care services organization providing end-of-life care, and as a member of nonprofit Boards of Directors serving frail elderly and terminally ill individuals. He is a senior strategic advisor to C-TAC, and recently was a Senior Fellow at Harvard University’s Advanced Leadership Initiative. Mark has been a partner in the Washington DC and Miami offices of Hogan Lovells (formerly Hogan & Hartson), where he was a founding member of both its Health group and its Miami office.
Over three decades, Mark has worked to structure, develop and expand innovative programs serving the elderly and terminally ill, including PACE, home care, and hospice programs. He served on HHS’s first Negotiated Rulemaking Committee, which reached a consensus recommendation on the hospice wage index that was adopted by the Medicare program. He also has worked on public-private partnerships to establish new medical research institutes, including Scripps Florida on behalf of The Scripps Research Institute and JAX Genomic Medicine on behalf of The Jackson Laboratory.
Mark holds Juris Doctor and Master of Public Policy degrees from The University of Michigan, and served as Managing Editor of the Michigan Law Review. He has served as President (Board Chair) of Hospice Care of the District of Columbia, and as a Board member of Comprehensive Care Management Corporation (now CenterLight Health System), which operates PACE programs in New York City.
Symposia and Events
The Project hosts a variety of public events and workshops with business leaders, policymakers, and legal scholars. Future events will likely include discussion of:
Policy options to promote improved advanced illness and end-of-life care
How to incorporate improved advanced illness care into delivery and payment reforms, for example, through patient-centered medical homes, bundled payments, ACOs, and other initiatives
Overcoming obstacles to successful advance care planning – engaging the community, providing access to care planning tools, and measuring congruity with expressed goals and preferences
Preparing for the “Silver Tsunami” – supporting the critical role of caregivers and addressing workforce shortages
Stretching the medical model – faith-based and other initiatives to mesh medical services with community supports
Person-centered care across the globe – can successes be transplanted without rejection?
Policy and Research Projects
Because the health care system evolved largely in a fee-for-service environment with siloed providers, current regulatory frameworks can impose obstacles to adoption of innovative models of caring for those with advanced illness. As the Project ramps up, it will engage in policy and research projects that will identify and analyze these obstacles, and propose policy solutions that promote development and scaling of successful programs. This may entail developing proposed regulatory approaches or a model regulatory framework for the advanced care delivery model that could be adopted by policymakers at the state and federal level. It also could explore potential payment methodologies for this model of care.
Project on Advanced Care and Health Policy Leadership
Faculty Director, Petrie-Flom Center
Professor, Harvard Law School
Executive Director, Petrie-Flom Center
Lecturer, Harvard Law School
Co-Founder and Co-Chair, Coalition to Transform Advanced Care (C-TAC)
Senior Fellow, Project on Advanced Care and Health Policy
Chief Strategy Officer, C-TAC