Difficult Conversations: 4 Key Results

PowerPoint PresentationDifficult Conversations: 4 Key Results from Advance Care Planning
Stephen Bekanich Chief Medical Officer Iris Healthcare Austin, TX
Presenter reports no known conflict of interest at time of presentation.
• Recognize how ACP Supports Key Outcomes
• Review Barriers to Adoption of ACP
• Identify Practical Solutions to Increase Adoption of ACP
Learning Objectives
#1 Driver of Healthcare Waste
$270B wasted annually on unnecessary care,
majority at End-of-Life
Serious Illness and Growing Quickly
25% Of Medicare Spend is in
the last year of life
Unnecessary And Unwanted Care
People with Serious Illness don’t just struggle with their disease
Patient Experience: Poor Quality, Too Expensive
- 5 -©2021 MGMA. All rights reserved.
Feel confused and helpless
53%
61%
Advance Care Planning
• Unnecessary Tests, Treatments & Hospitalizations
• Total Cost of Care
24.1% Avg. Savings During Serious Illness
Physicians Struggle with ACP
Barriers to ACP Conversations at Physician Level
ACP is the Most Difficult Conversation in Healthcare
TIME Having thorough
UNCOMFORTABLE Potential conflict, stress &
DOCUMENTS Cumbersome,
Source: Reich AJ, Jin G, Gupta A, Kim D, Lipstiz S, Prigerson HG, et al. (2020) Utilization of ACP CPT codes among high-need Medicare beneficiaries in 2017: A brief report. PLoS ONE 15(2): e0228553. https://doi.org/10.1371/journal.pone.0228553
of Medicare members with serious illness have
ACP conversations with their doctor
Randomized Control Trial
Control group: 2,039
4 Test group: 342
No control group members were offered ACP with Iris6
- - ©2021 MGMA. All rights reserved.
CATEGORY 2
Risk Stratification
Proprietary Targeting Algorithms Claims data is used to stratify members into risk categories based on predictive analytics:
• Major diagnoses + comorbidities • 2-year mortality risk • Cost prediction • Other ”Palliative” factors
Member Engagement
We’ve partnered with your doctor to offer you this service at no cost to you…
Direct Outreach Iris handles direct member outreach while keeping physicians & care team informed
Bringing care choices to life
Dear [FIRST NAME],
Iris Plans is a FREE Advance Care Planning service that is included in your health plan benefits. We are here to help you and your loved ones think about your future care, much like my family did.
I grew up living with my grandparents, Ama and Pop. They were my childhood heroes. I was heartbroken when they became very sick at the same time. My family had to think about where they should live, who should care for them, and what to do next.
Even though I’m a doctor, I found it very hard to make their care less stressful and easier to understand. That’s why I created Iris Plans.
Our goal is to help you feel safe to talk about future care choices and create plans to share with your care team. We know that healthcare is a very personal experience and journey. We want to help you and your loved one with yours.
Sincerely,
Delivered by Licensed Healthcare Professionals
Structured ACP Discussions Specially-trained nurses & social workers facilitate disease-specific ACP discussions with members & their families via video or phone
Proprietary & Confidential
State Specific Advance Directives Fully Compliant Directives, MPOA, DNR for all 50 States
My Planning Summary My Care Choices
Disease-specific, Plain Language & Upstream from EOL
Document Completion and Distribution
Full-Service Document Support Iris walks members through the document signing process & then distributes the executed Advance Directive package to Doctors, Hospitals, Health Plans, Member/Family and State Registries.
Status Communication
Iris provides ongoing support to enrolled members for 2 years including:
• Palliative Care referrals • Patient Communication and Coordination • Managing Hospitalizations Towards Care Goals • Ongoing ACP & Care Education • Document Updates & Redistribution • Care Shift Points / Hospice Education • Caregiver Support
Patient Preferences
Feeding Tube Preferences
Declined
Permanently
Temporary
Unsure
Hospitalization Preferences
Decisions Made
All Iris
Prefer Home
Prefer Hospital
Has Iris reduced any burden from your
workload?
If we continued with Iris, would you choose to keep
working with them?
service to your patients?
58% 100%
Yes Yes
Facilitator: Do you have any other questions for me about the documents or what to expect going forward?
Member: No. I think this is good as far as to able to give the kids so that they know what my wishes are.
Facilitator: Absolutely. Its kind of a gift to them to have on paper, in front of them what’s most important to you.
Member: Right, right. - 82-Year-Old Member
Net Promoter Score (NPS)
Decreased Utilization
Fewer ED Visits
Decreased Utilization
High Member Satisfaction
Strong Physician Satisfaction
92% Report Decreased Workload
S a a S
~60% ~30% ~9% ~1%
T E C H - E N A B L E D S E R V I C E S
Healthy Healthy/Chronic Conditions
Self-Serve ACP SaaS Platform Expert Live Support for Empower Users
Full-Service Clinical ACP Program (24 Months)
Decision-Making Support During ICU Stays
Suite of Solutions
• Outreach to Member: Mail, Text and Phone – multiple sequenced cadence
• Multiple engagements vs Straight Thru
• Type of Family involvement
• Document Completion: Voice signature, Touch Screen, Secure Email, Postal Service, and/or In-Person
• Early monitoring and benchmarking, each engagement is optimized to further customize the approach to the unique population
Medicare
MMPMedicaid
Iris Healthcare: ACP via Telehealth
More intense but less scalable • Smaller % of population • Complex medical management
Broad / Cost-Efficient Targeting • Larger % of population • Upstream from symptom management
Risk-scoring & triggers lead to warm hand- off to full-service PC
Full-Service Palliative Care
• ACP increases effectiveness PC
• More cost-effective solution
Stephen Bekanich MD [email protected]

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Difficult Conversations: 4 Key Results