Rebecca Lee, MD, a physician in Partners HealthCare’s North Shore Physicians Group, consults a cue card as she talks a patient through her goals for her last stage of life. Though the patient has a serious inherited disorder, her condition is currently stable—and that’s exactly the point. By having these important conversations before a crisis occurs, patients can really think about and express what is most important to them.

Dr. Lee recently completed training in end-of-life planning through a $750,000 grant partnership between North Shore Physicians Group and the nonprofit palliative care organization Care Dimensions. The training, which Partners aims to provide to all affiliated primary care physicians by 2020, helps doctors document their patients’ end-of-life preferences before medical crisis hits.

The benefits of such preemptive conversations are several-fold. For the patient, preferences documented in the medical record ensure their wishes concerning end-of-life interventions are observed. Through the Care Dimensions partnership, physicians like Dr. Lee can also refer patients for palliative care, which can support patients physically and emotionally as their condition declines.

Since about a quarter of Medicare spending takes place during patients’ last year of life, experts say these planning conversations could have significant cost-saving implications, aligning well with value-based shifts in the health care system. “If we are looking for opportunities to control health care costs, we see this opportunity at the end of life,” notes Sree Chaguturu, MD, Partners’ Chief Population Health Officer. And just as important, “if we actually do what matters to people, if we focus on the needs of individuals, their lives and their deaths are more under their control," says Dr. Don Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement.

Read more about the program in WBUR’s CommonHealth.

Topics: Integrated Care, Patient Experience, Medicare/Medicaid

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