The untapped value of advance care planning | Viewpoint

In the fast-paced world of healthcare, there are certain strategies that stand out as gamechangers. One such winning play that is growing in popularity is advance care planning (ACP).

While previously seen as a strategy to improve equity and patient satisfaction, new research suggests significant financial benefits associated with ACP. Much like a perfectly executed pick n' roll in basketball, ACP can become the go-to play for value-based healthcare organizations aiming to improve patient care while reducing expenses.

ACP, which involves discussing and documenting patients' healthcare decisions, is proving to be a powerful value-based care strategy to bring cost-saving wins while improving patient outcomes.

Numbers don’t lie: ACP’s impact

With studies published in JAMA Palliative Medicine, the American Journal of Managed Care (AJMC), NEJM Catalyst, and many other peer-reviewed journals, the evidence is clear that ACP can lead to more efficient, patient-centered, and cost-effective care.

A study published in JAMA Palliative Medicine showed that patients who had ACP discussions with their healthcare providers experienced fewer inpatient admissions and fewer inpatient days, translating to an average savings of nearly $9,500 per patient. Furthermore, the training and facilitation of this ACP program was not a sunken cost, with this investment yielding a 104% return on investment.

Research conducted by independent primary care network Aledade, published in AJMC, found that ACP yielded nearly $14,000 in reduced costs during the final 14 months of a patient's life. In an accompanying survey, 92% of responding physicians reported that they considered ACP a beneficial service and 58% reported that it reduced their own workload.

A study published in NEJM Catalyst showed that patients who had already completed the ACP process were admitted to the ICU had 24.5% lower costs and reduced ICU stays than patients without ACP. Patients with ACP prior to hospitalization also had lower use of inpatient palliative care consultations and a higher referral rate to hospice services.

Strategizing an ACP-centered game plan

Like a sports team adapting to new plays and strategies, the healthcare industry is undergoing a similar transformation. As value-based care becomes the new game plan, with CMS aiming for all Medicare participants to be part of an ACO by 2030, ACP programs are emerging as a multi-faceted solution to the challenges healthcare organizations face.

To maximize the benefits of ACP, organizations should consider the following strategies:

Educate and train staff. Provide healthcare professionals with the necessary training and resources to effectively facilitate ACP discussions with patients and their families. This includes understanding the legal and ethical aspects of these decisions and leveraging effective communication techniques.

Integrate ACP into routine care. Make ACP a standard part of the care process, especially for patients with chronic or serious illnesses. Regularly revisit and update patients' preferences as their health conditions and priorities change.

Promote collaboration. Encourage interdisciplinary collaboration among healthcare providers, including primary care physicians, specialists, nurses, and social workers, to better ensure a comprehensive and coordinated approach to ACP.

Engage patients and families. Empower patients and their families to actively participate in the ACP process by providing them with resources and support to make more informed decisions about their care.

Move beyond the completion checkbox as a metric of success. While completed plans on record are a key metric used to measure the impact of an ACP program, research suggests that such a focus on completion metrics reduces the quality and impact of ACP. Instead, focus on facilitating memorable and robust ACP conversations.

Consider partnering with ACP vendors/organizations. While there may be an eagerness to build an in-house ACP program, this is often a larger task than expected. Beyond building a patient-centered workflow that educates and engages patients, there are also legal requirements that vary from state to state. There are outside organizations that have already completed all the work necessary to launch an ACP, thus allowing organizations to jumpstart their program without burdening staff.

Embracing ACP as a game-winning strategy

The evidence is clear: ACPis not just a one-hit wonder. It's a winning strategy that's here to stay and one that has the potential to revolutionize the way we approach care while reducing healthcare costs. Consider implementing ACP to benefit your patients, equity outcomes, and the bottom line of your organization.

Desh Mohan, MD, is a practicing hospitalist and chief medical officer of Koda Health, which offers advanced care planning solutions.