For most nursing home residents, the time they spend in the skilled nursing facility falls at the end of their lives. This time is usually filled with stress, uncertainty and frustration. Skilled nursing providers have the job of giving patients the care they need along with the even greater role and responsibility to prioritize patients’ and families’ wishes on how the patient wants to spend their remaining time.
Much of this responsibility can be addressed — essentially providing an improved resident and family experience — through advanced care planning.
“Advanced care planning is the heart of how we deliver care that aligns with a member’s beliefs, and it is so important because when they are in the nursing home it’s usually about two and a half years they stay on average in a nursing home before passing,” Terry Wihlen, VP of clinical operations for Optum, said at 2024 Clinical, the post-acute care conference from Skilled Nursing News. “It’s important to be able to understand how they want to spend that time, how they want to be cared for. … It also gives them the autonomy to have some control over a challenging environment in today’s world.”
How Optum Approaches Advanced Care Planning
Offering a clinical delivery model of physician offices and surgical centers that encompasses I-SNP and IE-SNP plans, Optum’s approach to advanced care planning begins with the care and training they provide to their own clinicians. This includes access for onboarding nurse practitioners, physician assistants and RMs to a full one-day course in advanced care planning. Optum, a division of UnitedHealth Group, follows up with mentorship and monthly calls supported by Optum’s chaplain, medical director and other sources of support to clinicians regarding advanced care planning within Optum.
Optum’s clinician system is essential for patients, as it ensures that all clinicians have the support they need to make the best possible care decisions, even if they themselves are new to end-of-life care. Optum encourages difficult conversations with clinicians as it allows them to achieve a level of comfort in their practice. This model applies to I-SNP and IE-SNP participants, Wihlen noted, in turn helping patients understand their conditions and how they want to spend the time they have left.
“When I started, our leader at the time said when you think of how best to take care of each member, think of an upside down triangle,” he said. “Everything that’s supported around that member starts with the clinician, the nursing home, our sales, our business development, our overall clinical operations. Everything has to be aligned specifically to that one member each time.”
The Role Advanced Care Planning Plays in the Goals of Care
Optum’s approach stresses the importance of ensuring that patients receive the best care possible based on their wishes.
“We strive to reduce unnecessary hospitalizations,” Wihlen said, noting examples of illnesses that can be treated in nursing homes, including urinary tract infections. “When we think of what an advanced care plan is, it’s a detailed plan that’s done in advance of something that’s going to be acute.”
Optum aligns every order and intervention back to the member’s advanced care plan and its I-SNP plan is five-star rated due to high quality metrics. Advanced care planning saves families the stress and pressure of making decisions in an acute care setting and gives providers a point of reference regarding the member’s care. This doesn’t mean that changes in care aren’t possible, but reasons for change will be provided based on the advanced care plan.
“I tell my team every day if I don’t wake up in the morning aligning myself to the quadruple aim of health care, improving the individual experience, improving the health of populations, reducing overall medical expense and improving clinicians’ well-being, I won’t stay,” he said.
Optum, Inc. is an American healthcare services provider with business interests encompassing technology and related services, pharmacy care services and various direct healthcare services. It has been a subsidiary of UnitedHealth Group since 2011. Optum is committed to making health care work better, leading the way to better experiences, better health, and lower costs. To learn how, visit www.optum.com.
