For healthcare plans, achieving member quality of life goals can be challenging. Member goals differ on a case-by-case basis; documenting and following these goals requires time, expertise and consistency from every person involved in a member's care.

Unfortunately, these barriers often mean conversations about care goals never happen. In fact, one study found that even after a palliative care consultation, only 3% of people had finalized advance directives1.

In order to provide truly person-centered care, plans should incorporate member goals — such as living independently — into every care journey through advance care planning. Advance care planning provides a scalable, customized framework to determine and document member goals, ensuring that both members and providers are empowered to make the right care decisions based on the individual member's preferences.

Let’s take a look at how advance care planning can help some of your plan’s key stakeholders achieve member goals.

Empowering members

For plans to achieve member quality of life goals, they first need to know what those goals are! Advance care planning plays a crucial role in this process by helping each member define — and document — their quality of life goals.

Through a series of skilled conversations, advance care planning teams educate members and their families about their care options, empowering them to make the most well-informed care decisions. Without this education, members likely wouldn’t know how their goals line up with the various care options at their disposal.

After these planning conversations, members can then formalize their goals via an advance directive in accordance with their state’s regulations. This step is paramount; without proper documentation, members' goals are at risk of being miscommunicated or forgotten, making it difficult for plans to ensure they’re followed.

Refocusing providers

For people with serious illnesses, there often comes a point where the treatment they need conflicts with their own quality of life goals. At this critical juncture, it’s important that providers are able to refocus and deliver the care that best aligns with members’ goals — rather than defaulting to the next protocol.

As part of the advance care planning process, members receive comprehensive education about the benefits and burdens of their care options so they can make well-informed decisions. Likewise, careful discussions and documentation through advance care planning ensure providers are aware of quality of life goals before this critical juncture arises. This allows each party to use shared decision making to reach the best possible outcome.

Without these conversations and documentation, providers are often left to make quality of life considerations for members on their own, or rely on members' family members for their input. To avoid this scenario, robust advance care planning is a must.

ACP: The key to achieving member quality of life goals

Although at times overlooked, advance care planning is one of the most effective ways to achieve member quality of life goals. For health plans, this means:

  • Members receive only the care they want — decreasing unnecessary utilization
  • Providers are more person-centered and equipped to use shared decision making

If your plan is looking to achieve personalized, consistent and scalable advance care planning, Iris Plans is here to help. Our team of experts are trained to facilitate and document conversations about member goals, ensuring that your members are empowered and satisfied with their care. If you’d like to learn more, contact us today.

  1. Bischoff, Kara, David L. O’Riordan, Angela K. Marks, Rebecca Sudore, and Steven Z. Pantilat. “Care Planning for Inpatients Referred for Palliative Care Consultation.” JAMA Internal Medicine 178, no. 1 (2018): 48–54.