title: Telephonic advance care planning facilitated by health plan case managers.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Spectrum Health Medical Group,Byron Center,Michigan.
authors.forename: Iris
authors.initials: I
authors.lastname: Boettcher
authors.affiliation: Medical Affairs Department,Priority Health,Holland,Michigan.
authors.forename: Rozanne
authors.initials: R
authors.lastname: Turner
authors.affiliation: Respecting Choices,Gundersen Health System,La Crosse,Wisconsin.
authors.forename: Linda
authors.initials: L
authors.lastname: Briggs
mesh_terms: D032722:Advance Care Planning; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D008329:Managed Care Programs; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D010865:Pilot Projects; D013689:Telephone / Q000706:statistics & numerical data*
keywords: Advance care planning; Advance directives; Case management; Health plan; Telephonic case management