President and CEO, Bluegrass Care Navigators
President, Kentucky Association of Hospice and Palliative Care
Leadership style: Recruit great people, invest in their professional development, and create a culture where they can do their best work.
Mentors: I have a small group of CEO peers in the industry. They are trusted colleagues from around the country who I have nurtured a relationship through the years.
Dream job as a child: When I was in third grade, I was an awesome short stop and my dream was to be the first professional woman baseball player!
Books on nightstand: “Dopesick” by Beth Macy (Little, Brown and Company) and “Pain Killer” by Barry Meier (Random House) are currently on my bedside table. I am trying to understand how we arrived at the epidemic that is a reality my team members face every day. For fun, I am reading “Where the Crawdads Sing” by Delia Owens (G.P. Putnam’s Sons) and “AWOL on the Appalachian Trail” by David Miller (Lake Union Publishing). My daughter and I spent time backpacking the AT this fall and AWOL is helping to keep our adventure alive.
Hobbies: Playing tennis, renovating an old home and planning another backpacking trip.
Medical News: Looking back on the past year, how has the healthcare system changed and what is the physician community doing to adapt to the changing environment?
Liz Fowler: A continued focus on paying for value, improving care coordination and reducing unnecessary transitions has characterized U.S. healthcare over the past year. Providers are positioning themselves to thrive in a payment system that rewards value over volume and partnerships are becoming increasingly important.
MN: End of life is a challenging time for families and physicians. How would you like to change the dialogue?
LF: We know that seriously ill and terminally ill individuals are exposed to non-beneficial and potentially harmful healthcare utilization in terms of frequent visits to the emergency departments and subsequent hospitalizations. A contributing factor to this phenomenon is a lack of advance care planning and conversations with healthcare providers about goals for medical care.
Unfortunately, despite recognizing the importance of advance care planning, most physicians receive no formal training on this important skill. Bluegrass Care Navigators is committed to providing education to all healthcare professionals on how to skillfully communicate with the seriously ill.
Through a partnership with Ariadne Labs, the Center to Advance Palliative Care and VitalTalk, Bluegrass Care Navigators and the University of Kentucky have partnered to improve the communication skills of clinicians caring for the seriously ill and assuring that patient preferences are known throughout the health system. Look for more about this important initiative in the coming year.
MN: What recommendations do you have for the physician community as it relates to end of life care?
LF: While it may seem that we live in a death-defying culture, surveys show that patients and families want their doctors to initiative conversations about goals of care. Conducting goals of care conversations is a skill and there are several excellent resources to support physicians and other clinicians.
MN: What are the biggest challenges for hospice organizations in Kentucky?
LF: Despite hospice care being a benefit for the individuals in the last six months of life, half of patients who elect hospice receive care for 18 days or less. Consequently, many terminally ill patients and their families are not able to fully take advantage of the hospice benefit. Hospice clinicians often report feeling like they are practicing brink of death care rather than end-of-life care.
Bluegrass Care Navigators continues to provide professional and community education to correct misperceptions about hospice care and encourage early advance care planning.
Additionally, hospice providers in Kentucky are committed to managing intractable pain and bothersome symptoms while also safely prescribing and disposing of opioids. We worked closely with the general assembly to pass legislation that helps keep our communities safe.
MN: What was the biggest accomplishment for the hospice provider community this past year?
LF: Kentucky is fortunate to have 22 high-quality, community-based hospice providers. Most hospice providers in the state exceed national benchmarks for quality and have received distinction for excellence in care delivery and workforce. Hospice providers have a specially trained workforce with expertise in managing pain and symptoms and helping patients stay in their homes.
Additionally, hospice programs have a 24/7 on-call infrastructure to support patients and respond to crises any time of day. Because of the unique workforce and infrastructure, many hospice programs have created community-based palliative care programs to support people who need expert pain and symptom management, but who are not yet eligible for hospice care.