In an era where healthcare costs are soaring and patient-centered care is more critical than ever, two proactive care models — advance care planning (ACP) and kidney care planning —stand out as powerful tools to align care with patient preferences while driving down unnecessary spending. Both address some of the most costly and complex challenges in healthcare: end-of-life care, which consumes roughly 25% of Medicare expenditures, and chronic kidney disease (CKD), which represents a similarly staggering share of healthcare costs. Yet, despite their potential to improve outcomes and reduce financial waste, these planning processes are underutilized, particularly among underserved populations, leaving patients vulnerable to misaligned care and avoidable expenses.
Despite their benefits, access to ACP and kidney care planning remains inequitable. Underserved populations often experience lower participation rates, leading to misaligned care and poorer outcomes. Both models emphasize informed decision-making and proactive planning to avoid costly, unwanted interventions, highlighting the need for equitable access and implementation.
Empowering Patient-Centered Care Through Proactive Conversations
A common challenge in both ACP and kidney care planning is the lack of timely, structured conversations. Delayed or avoided discussions can result in care that does not reflect patients’ wishes. ACP focuses on helping individuals outline their preferences for medical treatment, particularly in end-of-life scenarios. This allows patients to define treatment goals, evaluate options, and ensure their preferences are respected if they become unable to communicate. However, ACP conversations are often overlooked due to time constraints or a focus on urgent health issues, leaving patients vulnerable to receiving care that may not align with their values.
Similarly, kidney care planning involves discussions about managing CKD, especially as the disease progresses. These conversations often include options such as dialysis, transplantation, or conservative management. Without these discussions, patients may miss opportunities to manage their disease effectively and may receive care that does not align with their quality-of-life preferences. Proactive planning in both ACP and kidney care ensures that patients’ wishes are known and respected, even as their health conditions evolve.
The Role of Patient Education and Support
Education is a cornerstone of both ACP and kidney care planning. In ACP, patients need clear, accessible guidance on end-of-life decisions, provided in their preferred language and tailored to their understanding. This empowers patients to make informed decisions based on their values and goals. It also allows them to inform and engage their family members and surrogate decision-makers in their planning.
For CKD patients, education is equally critical but broader in scope. CKD affects over 35.5 million Americans, and managing the disease requires understanding how to control factors like hypertension and diabetes to slow progression. Kidney care planning also involves educating patients about dialysis options, such as hemodialysis or peritoneal dialysis. Early education about these options is vital, as decisions about dialysis often arise under urgent conditions. Approximately 90% of U.S. dialysis patients are on hemodialysis, which requires frequent clinic visits, while peritoneal dialysis offers greater flexibility and can improve quality of life. Proactive education ensures patients can make informed decisions and avoid defaulting to less preferred treatments.
Ensuring Care Consistency During Crises
Both ACP and kidney care planning are crucial when patients become seriously ill and cannot communicate their preferences. Pre-established plans ensure that care aligns with patients’ wishes, whether it involves life-sustaining treatments or comfort-oriented care. For example, in kidney care, patients who have not expressed preferences are typically started on hemodialysis when admitted in an emergency situation — a treatment decision that may not align with their goals. Proactive kidney care planning allows patients to choose their preferred dialysis modality before emergencies arise, ensuring they receive the treatment they want when they need it most.
Cost Implications and the Need for Planning
Cost containment is a key motivator for both ACP and kidney care planning. Without advance planning, patients may undergo unnecessary, expensive interventions that do not align with their wishes. For instance, patients without advance care plans may receive costly, aggressive treatments aimed at prolonging life, which may not reflect their values. Similarly, kidney care planning can prevent emergency dialysis starts and associated high costs by guiding patients toward preferred treatment options. Studies suggest that a patient with an optimal start in the outpatient setting decreases pre-dialysis costs nearly $50,000 per year and post-dialysis cost by $16,565 per patient per year compared to unplanned starts. Proactive planning can also delay or avoid dialysis altogether by focusing on effective disease management, such as controlling hypertension and diabetes, thereby reducing the need for expensive interventions (National Kidney Foundation).
The Role of Digital Tools in Enhancing Planning
In today’s healthcare environment, digital platforms play a crucial role in streamlining both ACP and kidney care planning. These tools allow patients to record their preferences, share them with their care team, and update them as necessary. By providing quick, digital access to care plans, providers can make more informed decisions, even in emergency situations.
For ACP, digital solutions help patients outline end-of-life preferences, identify healthcare proxies, and ensure that their wishes are honored. In kidney care planning, digital tools help educate patients about their condition, guide them through treatment options, and document their preferences, making it easier for providers to deliver care that aligns with the patient’s goals. By automating and streamlining these processes, healthcare providers can alleviate the burden on already-overworked medical teams, ensuring that conversations and documentation happen at the right time.
Achieving Patient-Centered, Cost-Effective Care
Both ACP and kidney care planning are essential for delivering patient-centered care. These proactive approaches ensure that care aligns with patients’ preferences while managing healthcare costs by reducing unnecessary interventions and hospitalizations. ACP programs have been shown to save $13,916 per patient engaged, and kidney planning programs have been shown to drive 17% annual savings per CKD patient engaged. By prioritizing these models, healthcare systems can provide more personalized care, improve outcomes, and reduce financial waste, creating a more sustainable and compassionate system.
As healthcare evolves, ACP and kidney care planning offer a blueprint for delivering the right care at the right time. By focusing on patients’ values and ensuring their voices are heard, these models enhance both quality of life and the efficiency of healthcare delivery.
Desh Mohan, MD
Desh Mohan, MD, is a practicing hospitalist and chief medical officer of Koda Health, which offers advanced care planning solutions.
