SIC report cover

Improving Serious Illness Care in North Carolina

Published June 11, 2020


The Task Force on Serious Illness Care recognized that, with rising rates of many serious and chronic conditions in our state, it is crucially important to develop a system and culture that aims to improve the quality of living for individuals with serious illness, their families, and their communities. The recommendations developed by the Task Force serve as an actionable and achievable state plan to meet this goal. The Task Force on Serious Illness Care built recommendations using the previous and ongoing work of many experts throughout the state and nationally. In addition, the task force recognized the need for ongoing collaboration and governance to ensure implementation of the task force recommendations. Throughout the development of the recommendations, the task force was guided by principles of health equity, with a special consideration for the disparate impacts of serious illness among vulnerable populations, both in rates of specific conditions as well as in access to services and experience of receiving care.


The Task Force developed recommendations for improvements in care for individuals with serious illness, including care delivery and coordination, financing/payment for serious illness care, and addressing non-clinical needs. In addition, the Task Force identified recommendations for several important actions to ensure that individuals are able to identify and achieve their goals for care, including meeting the principles of patient and family engagement, improving the processes and understanding of advance care planning, and creating a system that supports family and communities as they care for those with serious illness. Lastly, the Task Force on Serious Illness Care developed recommendations for enhancing the health and human services infrastructure and workforce that delivers care to individuals with serious illness.


The North Carolina Serious Illness Coalition, which first convened in February 2020, will serve to provide organizational and implementation support as the recommendations move forward. As the Coalition and the many state stakeholders implement the recommendations developed by the Task Force on Serious Illness Care, our state will be able to reach the goal of improving quality of living for those with serious illness.


Note from the North Carolina Institute of Medicine: The recommendations contained in this report from the Task Force on Serious Illness Care reflect the task force process and deliberations completed in January 2020. In the weeks between January and the time of this report’s publication in April 2020, the COVID-19 pandemic developed across the world, including in North Carolina. The task force and the North Carolina Institute of Medicine acknowledge the many ways that the task force recommendations are impacted by and emphasized by the COVID-19 pandemic. In particular, we have seen how recommendations concerning access to care (especially through telehealth), improving insurance coverage, supporting caregivers (including through employer-based policies), improving advance care planning, and supporting the health care workforce, are of dire importance in this pandemic. In addition, we also acknowledge that the current and forthcoming economic situation of the state and nation may impact the prioritization and implementation of recommendations that seek expanded funding for serious illness services. Fortunately, the North Carolina Serious Illness Coalition, a key recommendation from the task force, has already started to meet to address how to implement task force recommendations and will play an instrumental role in identifying new and changing priorities. This Coalition will play a key role in identifying new issues for consideration as we meet the challenges COVID-19 presents now and in the future.  April 3, 2020

Download full report here