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The Gentle Path

All payers, including Medicare and Medicaid, can offer an insurance plan called, The Gentle Path.

Photo of Hattie Bryant
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Who is your idea designed for and how does it reimagine the end-of-life experience?

This can apply to everyone however could begin with all of us who are 65 years of age and older. The Gentle Path Healthcare Insurance plan requires that I name a proxy who will be contacted in the event I end up in the ER or ICU and can't speak for myself. When this person is called in the palliative care team is also called in to consult with the proxy adding its "whole person" care and removing ultimate power from specialist doctors.

The Gentle Path Plan is a choice that a person can make at the time of enrollment in any healthcare insurance program.  It will require that the enrollee name a proxy and a backup in case there comes a time when the enrollee is not able to speak for him or herself.

The Gentle Path Plan also requires the enrollee to answer a few simple questions about quality of life.

The Gentle Path means that when the enrollee is admitted to the hospital/ER/ICU that enrollee receives a palliative care consultation immediately.  Today these consultations only happen when a hospitalist, or one of the many specialists engaged on a case, make the request for the palliative care team.  In effect, the patient is in the hands of the aggressive care team and the patient and family are not even aware that there are options other than aggressive care.  

The palliative care team functions as the old family doctor used to function.  The team takes time to understand the person and the family in a wholistic way.  This results in patient- and family-centered care rather than doctor- and institution-centered care.

The Gentle Path Plan will require that a POLST be completed when the palliative team is engaged.   This is earlier than standard practice today.  

Research shows that when a patient and the family receive palliative care consultations, physician and institution evaluations improve, ICU days are cut and the patient often lives longer than those who stay on the do-whatever-it-takes path. 

The Gentle Path creates a win-win-win-win.  A win for the patient who isn't caught up in endless doctor appointments and trips in the ambulance, a win for the family who can relax and enjoy their loved one, a win for the physicians and hospitals who are now free to focus on true emergency cases that produce clear, positive outcomes, and a win for the payers.  No more dying in the ICU and move to comfort care sooner than later is the goal.

The Gentle Path Plan will provide support in the place the patient lives which could be a private home or some kind of assisted living.  While these services exist, this is the piece of the care that needs more effort.  

Incentivize The Gentle Path Plan by making the premium lower!

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

One Medicare ACO (Accountable Care Organization) could test this idea as these are managed groups of patients.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

Any person who works for a payer could take this idea and refine it. That person might even have the connections to implement the test! Any social worker could help with the coordination of support for The Gentle Plan enrollee who opts out of hospitalization.

Tell us about your work experience:

Early in my career I was a corporate trainer and convention speaker. I created the made-for-PBS television series called Small Business School and the video companions for 50 college textbooks. My new book, I'll Have It My Way, is about how to live fully all the way to the end.

This idea emerged from

  • An Individual


Join the conversation:

Photo of Hattie Bryant

Hi Ken,  I interviewed Dr. Lynn for my book but did not know about her Medicare option proposal.  I interviewed another physician who has since retired from an large payer who told me my idea would not get past the lawyer lobby in DC.  This is because The Gentle Path Plan might include forfeiting the right for a family to sue.  While we need the policy change, we probably need my cohort (I am 65) and those older than me to fight for this from the grassroots.  The power players are deeply invested in what they are doing now.  For example, hospitals make tons of $$ doing things that don't need to be done.  This might have to become like the organic food movement.  Consumer demand forced the power players to change.  For the many who are frail and poor, we could identify and reward care settings who are committed to the Gentle Path as so many are not.  One nurse friend "fought" with an assisted living place to respect her mother's DNH--do not hospitalize--order which was ignored at least three times.  If this were easy the problem would have been solved so we just have to keep at it!

Photo of Ken Rosenfeld

Hi Hattie, I liked your overall concept.  Have you read any of Joanne Lynn's work, beginning around 15 years ago, on Medi-caring?  She'd proposed a Medicare option for those who favored a care approach that paid for more home-based services/supports and avoided aggressive life-sustaining treatment approaches.  Dr. Lynn's concept has seen a couple of resurrections in more recent years, but remains a common-sense approach to matching insurance benefits to the needs of a frail, older population.