Community Conversations on Compassionate Care (CCCC) Program
Excellus BlueCross BlueShield
Community Conversations on Compassionate Care (CCCC) is a program developed by Excellus BlueCross BlueShield (Excellus BCBS) to help individuals over 18 years of age complete healthcare proxies and living wills. The program addresses the growing need for end-of-life care initiatives. Developers of the program state: "Without advance care planning, families and loved ones are left guessing the individual's wishes regarding medical care, life-sustaining treatments and if the resulting quality-of-life would be acceptable to the individual." The CCCC program was created soon after the publication of the Institute of Medicine's 1999 report, Approaching Death, Improving Care at the End-of-Life.
Key elements of the program include:
- identification of advance care planning as a developing process,
- introduction of storytelling for discussions of death and dying,
- application of behavioral readiness theory to engage patients in discussions of end of life,
- advertisement of "Five Easy Steps" to complete advance care planning and
- communication to Plan enrollees with useful tools and resources. In addition to these elements, the Plan set ambitious performance goals to ensure it stayed on track.
CCCC provides patients with ample information for advance care planning, such as advance care planning booklets, posters, brochures, workshops and videos. A survey was conducted in 2008 to assess the success of the program and obtain information about knowledge and attitudes regarding living wills and healthcare proxies. The survey indicates initial success with specific additional needs. For example, while 88 percent of adults in upstate New York believe that healthcare proxies are important, only 42 percent of adults have implemented them. This is higher than the national average. Completion rates for advance directives have stagnated nationally at around 30 percent. However, these rates are surpassed in Excellus BCBS' upstate New York service area, where there is a completion rate of 35 percent in the Utica/Rome/North Country region, 40 percent in Central New York and 44 percent each in the Southern Tier and Western New York. The highest completion rate for advance directives, 47 percent, is in the Finger Lakes Region where the community conversations began in 2004.
This program is valuable not only because it is tackling one of the most important problems in healthcare today, but also because it is available (via Excellus BCBS' Web site) to the community beyond Excellus BCBS members.
Program Contact: Patricia A. Bomba, MD, FACP, Vice President and Medical Director, Geriatrics, 585.238.4514, patricia.bomba@lifethc.com
