Advance Care Planning in Value-Based Care

Most people need some level of healthcare at the end of life. In fact, 25% of all Medicare spending occurs during patients’ last years, and research shows roughly 70% of adults prefer less aggressive treatments during their final days.

Still, few people have frank discussions about the medical services they’d like to receive before the time comes—only 17% of patients say they’ve talked about it with their doctor. Consequently, many individuals receive costly services they’d rather avoid.

Advance care planning can help patients sidestep this problem. Through this process, patients can clearly outline their preferences for end-of-life care. As a result, it’s easier for providers to honor their wishes. Often, their cost of care decreases too.

Understanding the importance of advance care planning and its benefits for both patients and providers can help move medical practices toward a more comprehensive value-based care model.

The Importance of Advance Care Planning

Advance care planning designates end-of-life care instructions based on a patient’s unique preferences. It is an integral component of value-based care which focuses on providing patients high-quality, cost-effective care. This end-of-life planning can include directives to physicians, medical power of attorney, and DNR (Do Not Resuscitate) orders. An effective plan delivers the right level of support to critically ill patients at the right time.

Along with identifying patients’ wishes, advance care planning can significantly impact how patients access end-of-life services. Research shows these conversations can reduce hospitalizations by 26%. In addition, patients who openly discuss their preferences more often rely on community-based palliative care and hospice services.

To maximize the impact of end-of-life planning, providers should have the conversations at the right time. It’s best to broach the subject as early as possible with each patient. This way, providers are fully aware of which treatments patients may want to pursue and how long they’re willing to extend their care. Plus, if given the choice, most patients prefer to die at home rather than in a hospital.

Start Advance Care Planning During the Annual Wellness Visit

Talking with patients about death can be uncomfortable. It’s an emotional and complex topic that’s hard to fully explore during a 15-minute visit. Instead, an effective plan requires an ongoing conversation.

Incorporating the topic into the annual wellness visit workflow may provide the easiest path to starting the advance care planning process. These appointments allow providers to include the discussion as part of a regularly scheduled touchpoint. Both the provider and patient can explore preferences and priorities in a relaxed environment rather than rushing to make decisions when anxieties may be high.

Under value-based care, incorporating end-of-life planning into an annual wellness visit is also a good financial choice for both the provider and the patient. If these conversations are included in this visit, the provider can receive between $80-90 reimbursement from Medicare per patient per visit. At the same time, patients don’t incur an additional co-pay.

Positive Impact on Patients & Providers

Advance care planning does more than support a patient’s healthcare wishes. Leveraging these discussions can also significantly reduce the cost of care, particularly for high-risk patients.

As part of value-based care, the Centers for Medicare & Medicaid Services seek to optimize care for patients with complex or chronic conditions, including at the end of life. Research shows providers can reach this goal by introducing advance care planning to patients who have the highest one-year mortality risk. In fact, monthly healthcare costs can drop by nearly $1,000 for patients who have these detailed conversations with their physicians.

Research also shows patients pursue fewer services and less aggressive treatments after having an end-of-life planning discussion with their providers, and they frequently report more satisfaction with the care they do receive. Additionally, many feel less anxious about their deaths than those who do not discuss their end-of-life preferences.

Physicians also benefit from having advance care planning discussions with their patients. When they understand their patients’ wishes, they can confidently provide appropriate patient-centered care. Among providers who incorporate these discussions into annual wellness visits, 92% report the benefit of these conversations. Plus, 58% say it reduces their workload as patients approach the end of life because they only focus on the services the patient wants.

Open conversations with patients about the end of life are rarely easy. And patients may be scared or unwilling to address the topic. But incorporating advance care planning into regular workflows can help provide patient-centered care and avoid delivering unwanted services. Overall, it strengthens the efforts toward adopting a successful value-based care model.