Advance care planning (ACP) and Shared Decision Making (SDM) enable individuals to start ongoing conversations about the kind of care they would like in the future, especially if they are unable to make those decisions for themselves. Having that conversation with your provider as well as your family can ensure that the care one receives is aligned with their goals, and is also known and understood by their doctors and their family members. However, many do not utilize these services as they could. Individuals usually engage ACP services at an annual wellness visit (AWV) or when they’re diagnosed by a specialist. ACP can improve the patient and family caregiver satisfaction with the care they receive and can help reduce the costs of care by reducing unwanted services. Rather than keep these services to just AWVs and at the time of a serious diagnosis, individuals should be encouraged to seek the services at other times.
Cultural, socioeconomic, and other barriers exist that prevent or disincentivize individuals from seeking ACP, leading to a loss of opportunity to utilize counseling services. Increasing the ubiquity of the services as healthcare can encourage more underserved groups to benefit. Populations, where this is most important, are Black, Indigenous, and People of Color (BIPOC) and dual-eligible beneficiaries (individuals who receive Medicaid and Medicare benefits). Individuals among these groups are more likely to engage in ACP, but less likely to go to an AWV. Without these prior conversations or a vision of care, patients are more likely to receive services they do not desire or increased hospitalizations.
C-TAC’s core principles for care models advocate for shared decision-making and care that assess a person’s needs on an ongoing basis. At C-TAC, to expand access to ACP, we have been working with members of Congress to eliminate one key barrier to ACP sessions that occur outside of annual wellness visits—the copay. Providers can bill patients for ACP sessions that occur outside of an annual wellness visit. Requiring co-pay results in more costs to users despite their motivation to engage in ACP. Eliminating the copay for these sessions would help increase their usage, particularly among low/lower-income individuals. Aligned with the Administration’s focus on health equity, no-cost ACP sessions are a step in taking an equity approach to provide a preventative service among historically under-resourced populations. Additionally, many medical providers report rarely billing for the service because of the lack of revenue generated. The legislation also enables licensed clinical social workers (LCSWs) to lead ACP conversations and bills for increasing the number of community providers who can lead these conversations outside of a doctor’s office.
With this new legislative opportunity in Congress comes a chance for our coalition to move on the policy that supports expanding access to ACP. Sharing stories about the benefits and the challenges of carrying a cost-sharing to ACP will be a powerful step in bringing this greatly needed service to those who need and want it.
