Advance Care Planning

Guided experience: behavioral triggers lead people through each ACP activity, nurturing and engaging them to ensure they complete and share their advance care plans. Includes legal advance directives for all U.S. states that can be completed via easy-to-use questionnaires and signed online with digital or electronic signatures. Paper-based advance directives or other advance care plan documents (DNR, POLST/MOST, etc.) can be uploaded as well.

Informed decision-making: educational materials support different learning styles, preferences, and health literacy levels to  make ACP accessible to everyone. Includes video, audio, and written content designed with a diversity and inclusion lens.

Comprehensive, holistic ACP: video living wills and supplemental values, priorities, and care goals exercises enhance advance directives, further structure productive and effective healthcare decision-maker conversations, and provide additional guidance for the care team.

Reimbursable ACP session focus: training and ACP session tools support a team-based approach to boost reimbursable ACP session delivery for both medically-necessary ACP and ACP in conjunction with Medicare Annual Wellness Visits. Session timers, ACP educational content to use during sessions (videos, worksheets, and handouts), and system-generated Medicare-compliant documentation make the delivery of high-quality, consistent ACP sessions possible for any staff member regardless of their experience.

Multiple delivery options: ACP tools and workflows support facilitated in-person as well as video or audio-only telehealth ACP sessions. Logical-branching scripts help the facilitator gather and store a person’s ACP data step-by-step in Honor My Decisions. Default scripts for different ACP session types are based on best practices and can be customized for your organization or specific patient segments.

End-to-end ACP session workflow: customizable training and implementation materials for front desk, scheduling, clinical, and billing staff ensure successful implementation. Aligns with existing ACP programs by providing the technology to enhance established ACP methodologies like Respecting Choices®, supporting healthcare system specific ACP forms and processes, and integrating with EHRs.

Custom dashboards: a variety of aggregate and individual utilization, performance, and behavioral metrics can be combined to meet business intelligence needs.

Compliance data: supports reporting for ACP quality measures performance, payor reimbursement audits, and other regulatory requirements.

Easy user and member administration: manage user access and roles, member rosters, and reporting groups.

Secure: online repository has multiple levels of security to ensure that privacy is protected. Each access to a plan is tracked and logged.

Accessible: indvidual plans are hosted at unique URLs and can be accessed 24/7 by scanning the QR code on the wallet card or clicking a link stored within the EHR or received via an email share by the plan owner.

Actionable: includes all elements needed to honor a person’s wishes: emergency contacts, healthcare decision-maker, treatment preferences, legal documentation, end-of-life values, and their video living will.