This July, we celebrate the 15th Circle of Life Award presentation at the Health Forum and AHA Leadership Summit in San Diego. The field of hospice and palliative care has come a long way in these 15 years. The Circle of Life Committee, comprising leaders and innovators from all disciplines, has reviewed and visited some of the most innovative programs. The vision of what palliative care can and should be has evolved greatly and what was innovative in 2000 has become routine in 2014. The award and the recognition it facilitates plays a key role in the advancement of the field and making sure these innovations take root and are replicated.

Now in 2014, there is a consistent emphasis on the continuum of care, care transitions and the management of patients with advanced serious illnesses upstream from end-of-life care — as well as innovative partnerships between hospitals, community-based agencies and ambulatory services — to create seamless support across sites of care.

Palliative care plays a particularly important role for patients with progressive illnesses and declining function who often get caught in the vortex of health care consumption. These are the 10 percent of our health care population whose escalating needs compel them to utilize the hospital and emergency department for lack of better alternatives.

Palliative care services that create a continuum of support from the acute care hospital to skilled care facilities to home-based care play a vital role in accountable care organizations, patient-centered medical homes, and within payer coverage benefits and population health management initiatives. For the first time, payment structures are aligning to support palliative care beyond the hospital setting.

The committee sees many opportunities ahead. Evidence shows that cancer patients who use palliative care support plus routine care earlier have improved symptom management and higher quality of life, and live longer. We look for evidence-based practices in symptom management, and for physicians and advanced practice nurses with communication skills to effectively facilitate primary palliative care discussions as well as to identify patients and families for whom specialty-level palliative care is warranted.

We look for programs that have developed supportive services for traditionally underserved populations. These include racial and ethnic minorities, children with chronic illnesses living into adulthood, and people with cardiac, pulmonary and neurological conditions that are advancing yet are still many months, if not years, from the end of life.

There will be an increasing need for the delivery of early palliative care services to those with serious and progressive illnesses and a rapidly evolving push to move palliative care beyond the acute hospital into the community. This will require innovative partnerships and evidence of close cooperation among organizations with common interests, demonstration of shared patient and family management, aligned incentives and integrated outcome measurements. It also will require partnerships among many institutional services, physician practices, clinics, academic institutions, formal and informal senior living communities, and community service programs and agencies.

What is your program doing that is innovative and contributes to this evolving field? Please share your stories and experiences by applying for the 2015 Circle of Life Award at and read, be inspired by and use the innovations shared by the 2014 honorees published in the August issue of Hospitals & Health Networks.

Martha L. Twaddle, M.D, FACP, FAAHPM, is chairman of the Circle of Life Committee and chief medical officer of the Midwest Palliative & Hospice CareCenter, Glenview, Ill.

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