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New C-TAC Report Identifies Best Practices for Increasing Use of Advance Care Planning

C-TAC has released the full version of a report designed to identify strategies that could be used to boost the use of advance care planning (ACP), a practice that is now more important than ever as we face the uncertainties of the COVID-19 pandemic. Discern Health, a healthcare quality and research advisory organization, developed the report. 

This research will help to further enhance C-TAC’s Advanced Care Transformation (ACT) IndexSM.  This project focuses on one of the 37 ACT Index measures, Medicare fee-for-service beneficiaries with advance care planning. The measure captures the percent of Medicare fee-for-service beneficiaries with an ACP-specific billing code recorded on a claim.

“Thoughtful conversations about goals of care are more important now than ever before as we face the challenges of the COVID-19 pandemic,” said C-TAC Executive Director Jon Broyles. “This report identifies several key practices that can be used to promote advance care planning across the country and ensure that people receive the care they want in the setting that is right for them.”

ACP is a process that has the potential to improve the quality of life and experiences of individuals and families during periods of serious illness when decision-making capacity may be impaired, and near the end of life, while reducing out-of-pocket and system-wide healthcare costs that might otherwise be incurred from unwanted or unnecessary treatment. 

Through a literature review, environmental scan, and a series of interviews with key informants to learn more about ACP from a “boots-on-the-ground” perspective, researchers collected evidence on factors affecting ACP and actions that can be taken at the state and community-levels to increase use. They identified seven key drivers that impact ACP, including patient and family engagement, provider education, and state policies and regulations.

The report offers a variety of specific best practices to promote ACP, including:

  • Recognizing racial and economic disparities in ACP and considering social determinants of health when designing programs
  • Creating educational programs for clinicians and healthcare organizations on the value of ACP and how to have meaningful conversations
  • Making ACP materials available in multiple languages to increase accessibility for patients and their families
  • Advancing state policies that support family caregivers, aligning policies with national and global efforts
  • Developing interventions that engage people with serious illness before they are in crisis

The research for this report was conducted before the spread of the Coronavirus but the strategies it outlines are all the more important during the ongoing pandemic. These best practices have the potential to be even more effective given recent actions taken by CMS to expand access to ACP services during this emergency. The agency recently announced that ACP services delivered via audio-only means would be billable to Medicare, which has been a key policy priority for C-TAC throughout the pandemic. Working in tandem with CMS and other federal and state policymakers, we can employ these strategies to ensure that people with serious illness have thoughtful conversations with their healthcare providers about their goals for treatment. These discussions can offer a measure of comfort and control for patients and families during this emergency.

“This research and report is an important leap forward in collecting and reporting ACP best practices and strategies. Respecting Choices® had the pleasure of working with Discern Health to provide feedback and we sincerely hope this provides a platform to promote continued sharing and access to ongoing lessons learned,” said Respecting Choices® Executive Director Stephanie Anderson, DNP, RN.

This research will serve as a valuable starting point as we continue to identify strategies for promoting ACP use. Researchers have used the ACT indexSM ACP measure as a benchmark to identify states with which we can partner going forward. C-TAC has recruited Regional Index Coaches in Hawaii, the highest performer on the Index’s ACP measure, as well as in Louisiana, which showed lower rates of ACP but evidence of progress. These coaches will identify opportunities to increase the use of ACP on the local level and share their expertise with collaborators on the ground. To learn more about our Regional Index Coaches, please visit our ACTSM Index page.

C-TAC will also be continuing the conversation by engaging with our members and partners. We will be reaching out via social media and other channels to invite them to react to these findings as well as to share their own lessons learned. In doing so, we can use this report to seed a living library of best practices that make it easier for those facing serious illness and their families to discuss and document their care preferences.

Advance care planning will also be a key topic of discussion during our National Policy Forum, taking place from 1 – 4 PM ET on Wednesday, June 24. This free, virtual event will feature timely updates and insight from leaders and innovators in our field on the effects of the COVID-19 pandemic on the policy landscape for serious illness care. Learn more and register today by clicking here.

For more information, please contact C-TAC Communications Manager Stephen Waldron at SWaldron@theCTAC.org.

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