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Health Plans: The Value of Advance Care Planning

Thursday, October 15, 2020

In spite of seemingly endless cost-saving solutions, it can be difficult for health plans to find solutions that are beneficial and appreciated by physicians, members and plans — but Advance Care Planning (ACP) is one of them.

The end results of ACP are impressive, yet they are not widely known. This is in large part because ACP interventions are often part of palliative care (PC) studies. PC is a field of medicine that has acknowledged benefits, but the specifics of what’s done through a PC program are still widely misunderstood by healthcare professionals. It’s noteworthy that most of what happens in PC is ACP. 

While PC is a challenging service to offer consistently at scale, health plans can still unlock the potential of ACP on its own. Here are some key benefits of ACP when applied to those

with serious medical conditions outside of PC (in other words, ACP delivered by non-palliativists).

Member satisfaction

The medical professional has long held the misbelief that people don’t want to talk about their future as it relates to their medical condition; this couldn’t be further from the truth. We are a society of planners – we plan for trips, retirement, education, and more. It makes sense to people to think ahead for anything of importance. 

Thus, it turns out that the healthcare system is the barrier to planning for care, not those in need of healthcare. In fact, public data is strong and consistent in demonstrating that people want to talk about care planning — they just don’t know how. 

Care planning can be an intimidating topic at first, but once opened — especially with understanding and trust — it becomes quite powerful for everyone involved. Members and their families may have miscommunications, misunderstandings and even conflict when it comes to

healthcare. While these difficulties arise out of love, they are not easy or straightforward

to resolve, and they often necessitate assistance from a healthcare insider. If you offer members this scarce but valued resource, you’ll see appreciation and loyalty improve for your most complex population. 

Net Promoter Scores are a standard for measuring how a person perceives their experience with any service received. Iris consistently achieves an NPS of +90 by those members who participate in our ACP services, proving that your members and their families want — and appreciate — access to ACP.

Physician experience

While it is difficult to get doctors to agree, they are aligned in recognizing that ACP is a crucial conversation. In fact, a strong majority feel that ACP is important for their patients. 

However, they have spoken loud and clear to set expectations that they won’t be the ones holding these conversations. Some of their reasons include: 

  • ACP is too time-intensive to be done during an office visit
  • ACP conversations are filled with stress, conflict, and other emotions
  • Getting the advance directives completed is a cumbersome process
  • A desire to maintain hope, and avoid signaling that they are giving up 

These sentiments translate into data around the ACP billing code that CMS released in 2017.

Over a three year period, audits show that the code is drastically underutilized. Only 2.4% of all medicare members received these services. Maybe more surprising is that only 4.2% of medicare members with serious illness had an ACP conversation recorded. It is no surprise then to see the physician experience improve when ACP is completed by

another party. 

Surveys of physicians whose patients have gone through the Iris ACP process note that a burden is lifted from them, with 58% of doctors stating that we’ve relieved a part of their workload. In the face of such a large instance of physician fatigue and burnout, having ACP provided for their patients is a source of relief for physicians.

Cost of care

America spends more wasted dollars on healthcare than any other nation in the world. At almost $300 billion dollars, the largest driver of waste in the US healthcare system is healthcare that can be described as unwanted, unnecessary, or non-beneficial. Most of this is spent during the last part of life. 

Typically, people make choices about their healthcare from a place of vulnerability, as there is a dramatic lack of information presented to them about their future. The reason for more than 70% of those with an incurable cancer believing that they will be cured is not blind optimism; it is a failure of the healthcare system to help them adequately prepare for the future with information that is both compassionate and caring and easy to understand and remember. 

When asked, most people equate the terms “treatment” and “cure.” In reality, these words have no relationship whatsoever, but physicians don’t take the time to help people understand the difference. In contrast, when healthcare professionals go through serious illness themselves,  they don’t have healthcare bills that are as high as the general public. It’s because healthcare professionals are masters at avoiding that which is non-beneficial. When members receive this same “insider information” about healthcare options, they make decisions that

mirror those a physician might make for themselves. 

Looking at the data for ACP interventions, we consistently see that when ACP is performed more upstream to the point of diagnosis, ACP will lower the cost of care by 20% or more. The savings in large part come from less ED visits, decreased readmissions and shorter/less intense hospital stays.

Learn more about how ACP reduces unnecessary utilization in our free whitepaper

Cost savings with compassion

ACP is one of the few standalone health plan solutions that can:

  • Improve the member and physician experience
  • Lower costs
  • And improve outcomes. 

ACP is a service that can be scalable and consistent across your entire population, especially with the aid of an external partner. If you’d like to learn more about how advance care planning can add value to your network, contact us today.

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