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Telephonic advance care planning facilitated by health plan case managers

Published online by Cambridge University Press:  10 June 2014

Iris Boettcher ,
Rozanne Turner  and
Linda Briggs
Iris Boettcher
Affiliation:
Spectrum Health Medical Group, Byron Center, Michigan
Rozanne Turner*
Affiliation:
Medical Affairs Department, Priority Health, Holland, Michigan
Linda Briggs
Affiliation:
Respecting Choices, Gundersen Health System, La Crosse, Wisconsin
*
Address correspondence and reprint requests to: Rozanne Turner, Medical Policy and Technology Assessment Administrator, Priority Health, Medical Affairs Department, 250 East Eighth Street, Holland, Michigan 49423. E-mail: [email protected]
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Abstract

Objective:

The insurance plan case managers (CMs) of Priority Health, part of a regional healthcare system located in Michigan, work telephonically with frail patients who have multiple comorbidities. However, these CMs have lacked facilitation skills for advance care planning (ACP) discussions in this vulnerable population. In 2012, the findings of a six-month pilot study of telephonic ACP (TACP) with some of the plan's Medicare population were implemented with Medicare members under case management.

Method:

Case mangers were trained and certified by Respecting Choices® to introduce and facilitate ACP discussions telephonically utilizing both First Steps and Last Steps protocols. The CMs identified appropriate patients using hospitalization and emergency room utilization data, severity of illness, and diagnostic criteria. The primary goal was to complete both the ACP discussion and the documentation for each protocol on identified patients. They also attempted to schedule facilitated conversations with the patients' healthcare advocates present.

Results:

During a 12-month period, 576 health plan members were offered First Steps discussions, with 198 interested in engaging in further ACP. Some 152 members were identified for Last Steps TACP using established criteria; discussions occurred with 56 members. TACP implementation resulted in 55 new or updated First Steps documents and 4 Last Steps documents. A total of 50 discussions included the designated healthcare advocate.

Significance of results:

Following TACP implementation with the Medicare CM team and evaluation of the results, processes and methods were instituted to increase engagement and completion of discussions and documents. These included enhancements to the electronic assessment and ongoing support of the CM team to increase the engagement of patients and advocates. Dissemination of the project to the entire Medicare CM team demonstrated opportunities and lessons learned for facilitated TACP discussions. The TACP model has the potential to be successfully utilized by other health insurance companies.

Keywords

Advance care planningCase managementHealth planTelephonic case managementAdvance directives
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 795 - 800
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

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