In general, the findings in the extant literature are inconclusive. The issue is further complicated by such factors as how participating physicians are organized to practice medicine and the relationship between the respective roles of the health plan and medical group or delivery system. Most of the interviewees reported that their respective organizations simply inform new enrollees through printed materials about advance directives. The interviewees expressed skepticism about the value of advance directives, citing several reasons for this attitude. Some plans check for a provider's notation in the chart that the subject of advance directives has been addressed with patients.
Health plans differ in how they relate to hospices.
A few own their own hospices, although Medicare beneficiaries eligible for this benefit may choose any hospice in the community. Since Medicare reimburses hospices directly, even for beneficiaries enrolled in managed care plans, MCOs are not required to have organized hospice arrangements. To address this concern, several MCOs have mounted physician education programs. Several examples are provided. Several of the initiatives that have been mounted may serve as useful prototypes.