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How to improve your Advance Care Planning (ACP) HEDIS measure

All HEDIS quality measures are important, but some are easier to move the dial than others. While rarely done without prompting, creating an advance care plan for medical decisions is one measure that can be dramatically improved, at scale, with telehealth and digital interventions.

HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures designed to provide information to make reliable comparisons of health plan performance.  HEDIS is made up of over 90 measures. One of the measures is for Advance Care Planning (ACP). The occurrence of Advance Care Planning is rightfully measured through HEDIS because it is so critical to end of life care, but yet, sadly, does not happen often enough.

In Advance Care Planning, individuals express and document their preferences for the kind of care they would want and who should speak for them if they are unable to speak for themselves. The absence of a plan can lead to unwanted, unwarranted care, physical and emotional discomfort and a poor quality of life for the patient. It can also cause stress and anxiety for families and loved ones who may not clearly know what the patient wants. And, without clarity of the patient’s wishes, it can lead to confusion among healthcare providers who are trying to do what is best for the patient. To cap it off, delivery of unwanted care, especially in end of life situations, can be very costly particularly due to more hospitalizations, greater use of the ICU and longer lengths of stay.

So, as a quality of care indicator, the ACP HEDIS measure requirement aims to systematically increase the number of individuals who have an advance care plan. This measure applies to Medicare populations.  It measures:

The percentage of adults 66–80 years of age with advanced illness, an indication of frailty or who are receiving palliative care, AND adults 81 years of age and older who had Advance Care Planning during the measurement year. 

In order to count, there must be evidence of Advance Care Planning during the HEDIS measurement year that includes notation (coding) in the medical record of a discussion with a provider or initiation of a discussion by a provider. Evidence of ACP must include one of the following:

  • The presence of an advance care plan or advance directive in the medical record 
  • Documentation of an ACP discussion with the provider (even if the member declines)
  • Notation that the member previously executed an advance care plan

There are no limits on the number of times an organization can report ACP for a given patient in a given time period.

When it comes to this Advance Care Planning (ACP) measure there is a significant opportunity to improve quickly, with minimal lift on a health plan’s part. Vital Decisions is focused directly on supporting health plans and their members with ACP services and fostering communication between patients and providers. Along the way this drives several measurable outcomes that impact the HEDIS score.

For example, doctors agree that if you only do one thing related to Advance Care Planning, naming a proxy is an important and influential first step. When a patient elects their proxy and alerts their physician it counts toward the ACP HEDIS measure. This is a primary part of all of our digital and telehealth ACP services, while driving the larger goal of helping people fully document their wishes.

Our programs set health plans on their way to achieving high ACP scores while lowering end-of-life costs by avoiding unwanted, unwarranted care. Our ACP experts are measured on how well they bridge the gap between patients and providers. All of our programs encourage members to document their wishes and talk with their doctors. Our services activate and guide members into important discussions that influence healthcare quality, member experience and the specific ACP measure. We engage with cultural humility and sensitivity, to ensure everyone has an opportunity to make informed choices and the confidence to make their wishes known.  Not to mention, our programs support all populations, not just Medicare members.

85% of members who conclude our Living Well program have documentation of advance care planning discussions in the form of selection of a healthcare proxy or living will, and 100% are encouraged to share their preferences and have these discussions with their doctors.

Through our telehealth and digital ACP solutions, for this HEDIS measure, we can make a significant impact on an entire population, guiding the trajectory of care for thousands of lives.

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