“I’d like to talk to you about decisions you might have to make in the future if you become very sick.”
Thus begins a video designed to make end-of-life care planning easier. It is one of nearly 300 decision aids now available for Aetna members and their families as part of a new pilot program to help bridge these difficult discussions.
“This is a very personal conversation,” said Vinnette Perry, director of Clinical Health Services for Aetna. “There’s fear of the unknown. We don’t always talk about how we want to die, and we don’t necessarily want to talk about a loved one dying.”
The pilot program, in collaboration with the nonprofit organization Advanced Care Planning Decisions (ACP Decisions), leverages their comprehensive video library to help patients and their families make the most informed medical choices possible.
Meeting members where they are
Aetna Medicare nurse case managers, who routinely work with members about end-of-life decision making, know that there is no one-size-fits-all approach. Each member faces unique challenges and has unique needs. For example, Perry shared a recent example involving a 77-year-old member with advanced heart failure who was overcome with emotion upon connecting with his case manager; not because of a fear of death, but because he was moved that someone cared. The conversation that began that day resulted in his decision to move across the country to be closer to family.
It’s estimated that less than 30 percent of individuals discuss end-of-life care with their loved ones, despite over 90 percent recognizing the value of such conversations.https://theconversationproject.org/ Aetna is committed to closing this gap by working to ensure end-of-life planning is a critical part of every member’s care plan.
For nearly 15 years, Aetna’s Compassionate Care program has helped seriously ill members and their families face the end-of-life on their own terms, without unnecessary stress or discomfort. The program features a proprietary algorithm that identifies members approximately 9-12 months before the end-of-life and provides them with comprehensive care management and caregiver support.
An opportunity to stop and think
Aetna’s multi-state pilot with ACP Decisions aims to enhance the Compassionate Care program by connecting Aetna’s vulnerable members and their families with evidence-based decision-making tools. It also encourages case managers to discuss end-of-life decisions with members who are still in good health.
“The videos empower patients and engage them in a way that simply having a conversation, or talking about advanced care planning in the abstract, doesn’t,” said Dr. Angelo Volandes, president and co-founder of ACP Decisions. “Our hope in partnering with Aetna is to make this routine and part of normal patient care.”
A series of interactive trainings for local case managers kicked-off in December 2018, demonstrating how to leverage these tools and past experiences in sensitive conversations. Since launching, case managers have seen the impact of these videos first-hand.
Sarah Fischer, an Aetna field case manager, believes the videos help members take control and draw the whole family into the discussion – even for those who feel they already have a handle on end-of-life decisions.
“The videos really make you stop and think,” Fischer says. “This program is giving us an opportunity as well as invaluable tools and confidence to talk with members about these difficult issues.”
The program is currently underway in Pennsylvania, Maine and Illinois, and will continue through the first half of 2020. The teams are monitoring success through a variety of measures, including hospice utilization, inpatient admissions and the completion of advanced care directives. In addition to arming case managers, the program is working to educate and train local providers to use these powerful video tools in their interactions with patients.
“These conversations result in better patient and family satisfaction and reduced unnecessary low-value care,” said Dr. Daniel Knecht, vice president of Health Strategy and Innovation for Aetna, adding that the discussions can even increase life expectancy.https://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678
Jaimie Marvin, a field case manager with a background in hospice care, points out that both members and their families appreciate the ability to understand and speak up about end-of-life.
“Although we don’t always know when we’ll have to say goodbye, it’s comforting to know that you’re protecting someone’s dignity through the final moments of their life.”