October 2021

Serious illness impacts an estimated 45 million Americans and their families/caregivers. Defined as “one or more chronic conditions that limit personal function and are likely to worsen rather than get better,” serious illness costs the US health care system nearly 1 trillion dollars a year, making up almost 60% of health care expenditures. People with serious illness often struggle to get the care and support they need to manage their conditions.

To address the needs of this population, Discern has partnered with the Arizona Coalition to Transform Serious Illness Care (AZ Coalition, led by the Arizona Hospital and Healthcare Association) and TopSight Partners to develop an HCBP Care Model based on evidence collected through a literature review, a state-wide survey, and conversations with payers, palliative care specialists, and patients and caregivers.

The AZ Coalition prioritized including services in the Model that would be best for patients, rather than services that are best supported by the current payment environment. The Model is also flexible in that it can be tailored to meet the needs of different communities and offer services that are not traditionally delivered by palliative care providers- including addressing social determinants of health.

The AZ Coalition anticipates developing an innovative value-based payment model and piloting the care and payment models at several sites.

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