As more of the U.S. health care system migrates towards value-based care, efforts on the part of payers and other stakeholders to promote advance care planning could lead to increased hospice utilization as well as earlier admission of prospective patients.

Advance care planning is designed to identify patients’ wishes, goals, and desires for their care up to and including the end of life, or if they become unable to communicate or make decisions. A key component of advance care plans is a Provider Order for Life Sustaining Treatment (POLST) form, as well as documentation of a proxy to make decisions on behalf of the patient should they become unresponsive.

These plans can reduce hospitalizations by as much as 26%, reduce health care costs, increase community-based palliative care and hospice utilization, as well as significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes.

Only 14% of patients with serious illnesses have advance care plans, with patients who receive palliative care being the most likely to have a plan.

“Advance care planning makes clear the patient’s wishes and values for end-of-life care; patients want clinicians to listen and explain things to them and when clinicians explain care and are transparent, patients are happier,” Brandon Stock, vice president of Innovation and Strategy for VITAS Healthcare, told Hospice News. “Surrogate decision makers often have tough choices, and research shows that there is less guilt and more comfort among people making those choices when an advanced care plan is in place.”

As more payers, providers and other stakeholders promote advance care planning, hospice organizations stand to gain. Documented discussions of patients’ wishes and goals allow opportunities for them to learn more about hospice and how it works and could lead to more patient choosing to elect hospice earlier in the trajectory of their illness.

“The advanced care plan model beings in normalizing conversations regarding health and advanced care plans. Generally, this happens when the patient is relatively healthy. The plan continues when the patient is diagnosed with a chronic illness and becomes more solidified as the illness progresses,” Stock told Hospice News. “When the clinician is no longer surprised that the patient’s passing is imminent, that is when hospice becomes involved. Hospice provider are then able to have those difficult end of life conversations. Research shows that patients are more likely to enroll in hospice if they have an advanced care plan in place.”

Payers and health care providers across the continuum of settings are increasingly advocating for stepped up advance care planning.

Blue Cross Blue Shield of Massachusetts (BCBS) is developing evidence-based tools using specific terminology found to help individuals feel more receptive to these challenging conversations.

A second insurance giant, Humana, Inc. recently partnered with health care technology company Advalt, Inc. to give all of its Medicare Advantage and commercial plan members access to a digital advance care planning platform called MyDirectives. Tools in the platform help individuals create and update advance care plans or upload existing documents.

Last December Aetna, in collaboration with the not-for-profit Advance Care Planning (ACP) Decisions, launched a pilot that augmented Aetna’s Compassionate Care Program, which supports advance care planning, using an extensive library of educational videos.

Health care providers themselves, including hospitals, health systems and many hospices, operate their own workshops or educational programs around advance care planning.

In additional to the work being done by health care providers and payers, advance care planning is gradually become its own industry, with companies such as ACP Decisions, Vynca, Uphold Health and a host of others building their businesses around associated services or technology. 

Driving this trend is increasing stakeholder interest in the ways advance care planning can reduce costs and improve the quality of care and patient and family satisfaction.

“The incentive is lower health care payments. Value-based care models are starting to require increased advanced care planning documentation — for example Primary Care First —  and that leads to decreased health care costs,” Stock said. “The intersection between with value-based care is that advance care planning improves the quality of care by becoming more patient centered.”