Community Conversations on Compassionate Care (CCCC)
An Advance Care Planning Program
A Community-Wide End-of-Life/Palliative Care Initiative Project
Definition and Needs Assessment
Program Definition
CCCC is an advance care planning program designed to motivate all adults
18 years of age and older to complete traditional advance directives like the
health care proxy and living will.
Needs Assessment
Interventions
Identify advance care planning as a process, not just form completion
Use storytelling to discuss death and dying
Apply behavioral readiness theory to engage consumers
Regional variations in cost of care
Employ “Five Easy Steps” to complete advance care planning
Regional variations in percentage of deaths occurring in hospitals
Maintain consistent messaging in all tools and resources
Impact of conflict over treatment on families
Advance Care Planning Booklet
Functional health illiteracy
CCCC Workshop
Low completion rates of advance directives
CCCC Video
National Metrics
www.CompassionandSupport.org website
1991 — Patient Self-Determination Act: 20% had living wills
2002 — Means to a Better End: 15-20% had advance directives
2005 — Pew Research Center: 29% had living wills
2008 — AARP Survey: less than 40% had advance directives (35+ y.o.)
Even fewer Americans have had honest conversations regarding end-oflife care wishes, a vital component to the advance care planning process.
CCCC Program Outcomes:
Community Survey
CCCC Program Outcomes:
Serial Employee Surveys
The End-of-Life Care Survey of Upstate New Yorkers:
Advance Care Planning Values and Actions, Summary Report
(2002, 2006, 2008)
Commissioned by Excellus BlueCross BlueShield in March and April 2008
The survey explored several issues:
Awareness and knowledge about health care proxies and living wills
Completion rates for health care proxies and living wills
Reasons for not completing a health care proxy form
Discussion of advance directives with family and personal physicians
The survey results provide comprehensive attitudinal and behavioral
assessments for two important advance directives and identify factors
that most influence these attitudes and behaviors in the community.
The Employee Health Care Decisions Survey
Each survey assessed employee knowledge and behavior regarding
advance directives. The 2006 and 2008 surveys were compared with previous data. The 2008 survey results were also compared with the
results of the 2008 End-of-Life Care Survey of Upstate New Yorkers.
Key Employee
Survey Outcomes
Specific issues explored on the surveys included:
Awareness and knowledge of health care proxies and living wills
Next Steps
Completion rates for health care proxies and living wills
Barriers to completion
Discussions of advance directives with personal physician
Key Community Survey Outcomes
Community: National Quality Forum
Increase completion rates of healthcare proxies
Increase conversations between patients, families
and providers regarding patient preferences
Implement New York’s MOLST Program statewide
Create New York advance directive/MOLST registry
Expand CCCC throughout NYS and nationally
2002 Press Conference
David Klein, CEO, Excellus BlueCross BlueShield, and a panel of community leaders from diverse spiritual and cultural organizations held a press
conference to announce a major new campaign to help improve the quality
of care at the end-of-life.
Health Plan
Extend ACP further in Care Management functions
Incorporate ACP in all product lines
Model Healthy Blue Incentives Program
Gather employer support
ACP employee campaign as Worksite Wellness
CCCC Performance Goals
Every adult (at least 18 years of age) will complete a health care proxy
Every adult will receive education on advance care planning
Increase comfort level discussing death and dying
Increase conversations that lead to completion of advance directives
Employer ACP toolkit
Establish partnerships with other Blue Plans