Category Archives: Social change

Hospices Gain from Value-Based Advanced Care Plan Initiatives

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, VyncaUphold 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.”

MD Health Information Exchange Expands Advance Care Planning

CRISP, Maryland’s state-designated health information exchange, will increase integration of its advance care planning solution.

The Chesapeake Regional Health Information System for our Patients (CRISP), a health information exchange (HIE) covering Maryland and Washington DC, recently announced plans to expand technical integration of its advance care planning solution.

CRISP will use advance care planning provider ADVault to further efforts to give providers access to more meaningful patient health information during patient encounters.

The HIE first integrated ADVault into its database five years ago. The newest ADVault deployment will incorporate global healthcare data content and transport standards into the HIE, enabling CRISP partner hospitals to receive real-time advance care planning data automatically.

Dig Deeper

This data will help to improve clinical efficiency during patient encounters to improve patient health outcomes across the state of Maryland.

“Our prior work with ADVault required healthcare providers to manually access a secure portal and run a query to retrieve a patient’s advance care plan,” said Ryan Bramble, Senior Product Director at CRISP.  “Now, we automatically deliver patient advance care planning information in-context, regardless of the EHR, at the point of care.”

The ADVault MyDirective’s solution is a cloud service enabling users to digitize their healthcare goals by creative advance care plans or uploading advance care plans, advance directive, ir portable medical orders. The solution also allows users to attach audio files and video messages to care plans to ensure patients and providers understand intent and expression.

ADVault’s solution also works with health insurance plans, providers, and EHR vendors in addition to HIEs to help clinicians access documents.

“CRISP’s upgrade to our repository helps providers get information critical to patient care,” said ADVault Director of Product Mike Munoz. “This improvement drives to the core of our mission: that people live with confidence their voice can be heard in their care, even if they can’t communicate at that time.”

CRISP is a regional HIE serving Maryland and Washington, DC. The HIE has been formally designated as a statewide HIE and operates under the Maryland Health Care Commission.

“This is important progress for the citizens of Maryland and the medical professionals that serve them,” said CRISP Chief Operating Officer Brandon Neiswender. “We look forward to integrating even more enhancements in the near future, keeping Maryland at the forefront of values-based care.”

In 2018, CRISP adopted an application programming interface (API) gateway into its infrastructure to improve health data exchange and EHR interoperability for hospitals across Maryland, West Virginia, and the District of Columbia.

In a white paper, CRISP detailed how the implementation of an API gateway within the Microsoft Azure cloud environment specifically improved health data exchange and use with help from consulting and software development solutions provider Leap Orbit and funding from the State of Maryland.

The new API-based infrastructure helped CRISP improve its ability to exchange discrete, relevant pieces of clinical data into clinical and administrative workflows. Providers will be able to use the API gateway to access CRISP’s alerts registry and future data repositories.

“As of June 2018, the In-Context service has been the most widely deployed of the three services listed above,” stated CRISP officials. “As a result of this effort, critical information from the CRISP HIE is now directly embedded in the EHRs of thirty-seven out of the forty-seven hospitals across Maryland, with the last ten under development.”

Since implementing its in-context services in 2016, average monthly query volumes at the HIE have risen from 150,000 queries to 1.7 million, according to CRISP.