BCBSMA Invests in Electronic Registry for End-Of-Life Care Quality

With funding from Blue Cross Blue Shield of Massachusetts (BCBSMA) and the Massachusetts Coalition for Serious Illness Care, Massachusetts is developing an electronic registry of patients’ end-of-life preferences to ensure providers have necessary information access to deliver compassionate, high-quality care.

Andrew Dreyfus, president and CEO of BCBSMA and founding member of the Massachusetts Coalition for Serious Illness Care, explained that the statewide electronic registry will serve as a single source of trusted information that will ensure providers deliver care in a way that aligns with a member’s individual wants and needs.

"Far too often, people don't get the care they want,” Dreyfus said in a press release. “It was clear there was a huge opportunity to improve this part of the health care infrastructure so that clinicians all over the state can quickly access patients' documented preferences for their care when it matters most."

Patients who are seriously ill often outline their wishes for the types of end-of-life care they may want to receive. Do not resuscitate orders (NDRs) are key examples of those care wishes, but end-of-life treatment can move beyond that scope. Patients may also assert that they do not want to receive intensive, invasive, and often costly care interventions if they are unlikely to survive.

The electronic registry will include physician orders for life-sustaining treatment, or POLST forms, which allow people with serious illnesses to express their wishes for end-of-life care. However, these important documents are often not utilized in end-of-life care because they are often poorly filled out or hard to find. 

Massachusetts follows several states, including California, New York, and Oregon, that have introduced statewide electronic registries to help ensure that patient end-of-life preferences are fulfilled across the healthcare continuum.

Previous studies on the current Massachusetts POLST program, MOLST, have found that these documents don’t always  follow a patient across different sectors of the healthcare ecosystem. Additionally, MOLST forms often include conflicting or incompatible choices, leading providers to ignore them due to validity concerns.

Many MOLST forms are also filled out without a high-quality patient-provider conversation about what truly matters to patients and their loved ones.  

The Commonwealth will rework its POLST form to align with national standards, thereby giving providers the most accurate, clear depiction of an individual’s preferences. Additionally, the Commonwealth will conduct extensive outreach and education about the new form, as well as how to use the online registry.

The MOLST-to-POLST Advisory Group, headed by the Coalition for Serious Illness Care, is engaging with stakeholders to develop the form, including representatives from Ariadne Labs, Honoring Choices Massachusetts, The Massachusetts Health & Hospital Association, The Hospice and Palliative Care Federation of Massachusetts, Massachusetts Medical Society, and UMass Memorial Health Care.

"This is a huge gift to the people of Massachusetts," said Erik Fromme, senior scientist and faculty lead of the Serious Illness Care Program at Ariadne Labs. "An e-registry can catalyze major improvement in our ability to honor patients' preferences when they are seriously ill. It's a powerful tool to support first responders and ensure that patients get the right care no matter where they are."

Lachlan Forrow, a Coalition Advisory Group member who co-chaired the Commonwealth's earlier Expert Panel on End-of-Life Care, echoed Fromme’s sentiment.

"This is a great breakthrough in an area of health care that is important to every patient and family member in the Commonwealth," Forrow said.

With Blue Cross and the Coalition for Serious Illness Care’s funding, the Massachusetts Executive Office of Health and Human Services were able to secure matching funding from CMS.

"We appreciate the visionary leadership of BCBSMA and this generous gift to help revitalize our serious illness program and support a new POLST form and ePOLST registry," said Ellen DiPaola, president of Honoring Choices Massachusetts.

Lauren Peters, undersecretary at the Executive Office of Health and Human Services, noted that public-private partnerships like this one are key in advancing quality of care across the Commonwealth.

“This important initiative will promote compassionate end-of-life care for Massachusetts residents," Peters said.