Dallas-Based Startup Wants to Be “Facebook of Advance Directives”

Scott Brown

MyDirectives co-founder Scott Brown has a goal: for his website to become “the Facebook of advance directives.

MyDirectives is a web-based system that allows enrollees to create and update their advance directives free of charge, and can be accessed by enrollees or their providers anytime. The HIPAA-compliant database is the first advanced care platform to receive “meaningful-use” certification from the Department of Health and Human Services. The system can be used as a plug-in for electronic health records or as a stand-alone website.

Advance directives attempt to take the guesswork out of figuring out a patient’s wishes and values about end-of-life care. They are legal documents that establish guidelines for which treatments patients wish to receive – or not receive. They also may designate who will make treatment decisions for them if they are incapable. They include a living will, which can include choices regarding do-not-resuscitate orders, artificial breathing and feeding, and organ donation. A durable power of attorney designates someone to make end-of-life decisions on your behalf if you are unable to do so.

Brown and Jeff Zucker started their Dallas-based company after years of research. The system has a patent-pending approach called the Universal Advance Digita Direct (uADD), which is the first all-digital directive accepted internationally. The uADD simplifies more than 200 legal forms used in the United States and allows users the opportunity to include audio and video messages to augment the advance care plan.

Advance directive forms are different in each state. Brown, who is an attorney, said people legally have “the right to write their wishes on a napkin. This (system) is an evolution to substance over form.”

More than one in four elderly patients become incapable of making end-of-life decisions. Those with advance directives nearly always got the treatment they wanted. Notably, of those who had directives, only 2 percent wanted aggressive end-of-life care, according to a New England Journal of Medicine study.

In 2008, Congress added discussion of directives to the initial “Welcome to Medicare” preventive exam, The comprehensive exam is free in the first 12 months for new beneficiaries. The 2009 health-reform effort to reimburse physicians for these kinds of discussions at any time spawned the famous and fatuous “death panel” demagoguery. Readers of PolitiFact, a fact-checking website, overwhelmingly anointed “death panels” the 2009 “Lie of the Year.”

When people are asked to imagine themselves incompetent and with a poor prognosis, more than 70 percent say they would refuse life-sustaining treatment. Only 1 in 8 nursing-home residents want aggressive end-of-life care, even though that is what they get if their wishes are unknown.

The medical community in La Crosse, Wis., has made a commitment to ensuring that patients complete advance directives. As a result, 96 percent of its residents die with such forms filled out. The cost of care at the local hospital in the last two years of life is about $18,000, compared with the national average of $26,000.

Advance directives also lift the emotional burden off loved ones responsible for making care decisions. Family members unaware of patients’ wishes take nearly two weeks longer to decide to withdraw medical care. That can become expensive. The cost of care in the last week of life is 55 percent higher for those who have not had these discussions.

A 2008 federal report to Congress said that 18-36 percent of Americans have any form of advance directives. For those who do, physicians are unaware of them. A 2007 student in Critical Care Journal found that only 1 out of 4 physicians knew that their patients had advance directives on file.

According to a Time/CNN poll, 7 out of 10 Americans say they would prefer to die at home. According to the Centers for Disease Control, only 1 out of 4 do so.  One-third of developed nations’ annual healthcare spending goes toward medical costs for in the last year of life. Of that, 40 percent is spend in the last month. In the U.S., only 7 percent want life-sustaining treatment but 68 percent of end-of-life patients will receive it because they lack advance directives.

Brown said an independent actuarial study found that effective use of MyDirectives by Medicare beneficiaries and their providers could save the federal program more than $85 billion annually.

Brown would not say how many people have used MyDirectives for competitive purposes. However, he said traffic has increased 133-200 percent a month since the service was launched around Memorial Day. He said the Baylor Health Care System has been a critical supporter in driving traffic to the website, and organic web searches have also been instrumental.

Brown said the company is striving for a “tipping point” of 2.5 million enrollees, which he estimated could happen in 18-24 months.

The company is attempting to raise $5 million in venture capital for consumer marketing and to build out its management team. He said several interested investors are awaiting the presidential election results before committing capital to the project.

Brown said he is working with several health plans, the Department of Defense and the Veterans Administration,and the health ministries in Canada, France and the United Kingdom about using the service. He said MyDirectives would charge a small monthly fee for each enrollee for storing the directives. He said enrollees would never be charged directly for using the service.

The company’s immediate target market is aging consumers, especially those in assisted living housing. Its next target is to capture everyone over 18, and to make advance directives as easy and convenient as donating organs. Ultimately, it wants to be the premier database for advance directives worldwide.

To build awareness of advance care planning, the company launched an I Decide campaign last week in conjunction with the fall election campaigns. The effort generated more than 5,000 supporters in less than 24 hours. Brown said the campaign was designed to show lawmakers and insurers that people want to talk about end-of-life planning, and to show investors that publicity can generate enrollees at little cost.

“Sarah Palin set the whole thing back about 10 years,” Brown said. “Politicians think this is a toxic subject. If you ask, consumers, they want to talk about this.”

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.