Telehealth Advance Care Planning Cost Effectiveness

Author(s): Marvin J. Gordon, Tao Le, Ferdous Kabir

Objective: A telehealth advance care planning (ACP) program was evaluated for efficacy in enrolling members, creating advance directives (AD), decreasing utilization, and lowering medical cost during a two-year period.

Study Design: 7,089 members from multiple insurance products were identified as high-cost/ high-risk members for referral to a telehealth ACP vendor. Members not enrolled created the comparison group of 6,775 members.

Methods: Members were enrolled in 2020. The enrollment process was tracked for participation in ACP discussions and creation of AD. Cost savings and utilization were analyzed for calendar year 2020 and 2021 comparing the enrolled and comparison groups.

Results: Of the 314 members enrolled, 60.8% identified their preferences, and 20.4% generated an AD or a Provider Order for Life Sustaining Treatment (POLST). The enrolled group was 65.9% Medicaid, 7.3% commercial, 23.2% Medicare Advantage, 2.6% Medicare/ Medicaid Special Needs, and 1.0% other. The total medical cost for members enrolled in the ACP program was 33.3% lower than the control group in calendar years 2020-2021. The savings were mostly from a decrease in in-patient utilization. Emergency room visits were 10.2% higher in the intervention group.

Conclusion: Despite generating ACP documents in only 20.4% of those enrolled in a telehealth ACP program, a significant decrease in total medical cost (33.3%) was seen in 314 high-cost/ high-risk patients in 2020-2021 compared to controls. This would suggest that telehealth ACP can be accomplished, and cost savings appear to be more likely driven by the ACP conversation than by the completion of documents.