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Promoting Individualized Care with Advance Care Planning and Palliative Care

Wednesday, March 31, 2021

Caring for critically ill individuals during a medical crisis involves complex decision-making on the part of both healthcare providers and families. Communication strategies aimed at facilitating decision-making for individuals and surrogate decision-makers have shown an improvement in patient and family emotional outcomes. Interventions that target increasing the frequency and quality of communication about future medical care can ensure that care remains patient-centered and is respectful of individual preferences and values. 

Interventions that improve the quality of care, such as advance care planning (ACP) and palliative care, while reducing unwanted expensive medical care, should receive increased attention. These interventions seek to individualize care, matching medical care to treatment preferences of informed individuals and their families. There is evidence that suggests that providing patient-centered care can lead to a reduction in intensity of care, reduce hospital admissions and reduce hospital length of stay for seriously individuals. 

Advance care planning for those with chronic illness helps provide clarity to individuals and their families, helps ensure patient preferences are made clear regarding the type and level of care they’d prefer and to ensure that care is delivered. ACP has also been shown to improve patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.

Palliative care focuses on complex pain and symptom management, communication about care goals, alignment of treatments with patient values and preferences, transitional planning, and support for the family. This type of care is seen as an essential component of comprehensive care for individuals with chronic illness, including those receiving aggressive intensive care therapies.

Cost Savings with ACP and PC

Both advance care planning and palliative care have the potential to result in significant cost-savings. A 2018 study from the Journal of Palliative Medicine examined the cost savings from implementing an ACP program within a Medicare population. The three-year, case-control study found that overall adjusted care costs were $9,500 lower for individuals who had participated in the ACP program compared to those who had not. Including training and labor costs, the ACP program cost $1,515,170 in total and generated $3,087,500 savings in Medicare expenditure. Net savings from the program during the study were $1,572,330, resulting in a 2x ROI.

A study analyzing data from 2004-2007 at four New York State hospitals found that individuals who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of individuals who received usual care. These reductions included $4,098 in hospital costs per admission for individuals discharged alive, and $7,563 for individuals who died in the hospital. Consistent with the goals of the majority of individuals and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care individuals. 

Brad Smith, Director of the Center for Medicare and Medicaid Innovation (CMS Innovation Center) and Senior Advisor to Secretary Azar for Value-Based Transformation, noted the importance and impact of palliative care in healthcare, “Over the past five to ten years, a number of studies have repeatedly demonstrated how advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.”

Centers for Medicare and Medicaid Services (CMS) recognizes the important roles ACP and palliative care play for critically ill individuals. They have begun incentivizing increased utilization through ACP/palliative care-based quality measures, and associated financial incentives, in programs like Bundled Payments for Care Improvement Advanced (BPCI Advanced) and the Oncology Care Model (OCM). The new Primary Care First program also includes ACP quality measures that are used to determine performance-based adjustment eligibility, and payment for APC CPTs will be included in the quarterly capitation payment for Chronic Kidney Disease through the new Kidney Care Choices Model as well. 

Expanding Utilization of ACP and PC

Despite the documented benefits for individuals and caregivers, utilization of ACP and palliative care still remains low. While CMS has aligned financial incentives and performance metrics around increased use of palliative care and ACP in value based care models models, gaps still remain in the integration of these services across providers and institutions providing care to seriously ill individuals. One of the persistent challenges to adopting ACP processes and integrating palliative care programs has been the lack of time and resources available to providers and health systems. 

Partnering with an experienced third party vendor whose sole focus is on scaling access to ACP and palliative care is critical in the successful implementation of these interventions. At Iris, our goal is to seamlessly integrate advance care planning into your workflow so you can focus on improving plan performance and physicians can focus on providing patient centric care. 

Iris takes ownership of the entire ACP process and champions the benefits of ACP to your patient members and physicians. We take the burden of having these conversations off of the providers and remove the barrier to having these discussions. Our team manages the entire ACP process including member identification, engagement, expert led ACP facilitations, documentation completion, and distribution to family and care teams. During initial and follow up conversations our facilitators can make palliative care referrals, we connect people to in-person palliative care based on symptoms requiring medical management, utilization patterns, or challenges in social determinants of health.

If you’re ready to explore an advance care planning partner, Iris is here to help you identify specific care planning solutions for low, medium, and high risk member populations.

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