The problem you already know
You have had the 2 a.m. conversation: a patient with advanced COPD or lung cancer, a family that isn't sure, a chart that says nothing useful about what the patient would have chosen. Only 37% of US adults have an advance directive, and the ones that exist are rarely accessible when a decision has to be made. Seventy percent of end-of-life care does not match what patients said they wanted. The cost of that gap, in care nobody asked for, runs to about $3.2 billion a year.
The problem isn't that nobody documented. It's that what was documented was written for a lawyer, not for you.
What Sanctuary does
The patient does the authoring. Over a guided series of sessions, in their own words, they record what matters to them across seven rooms of their plan. Sanctuary then produces the patient's Medical Blueprint and, from it, role-specific Care Guides: a clinical summary for the pulmonologist, a bedside brief for the ICU team, a practical guide for the care navigator, a plain-language version for the family.
The patient publishes and shares each guide; you can print it or place it in the chart today. We're building toward delivering guides directly into the records you already use.
The revenue you're already earning but not billing
Your clinicians have some version of a goals-of-care conversations every week. Most of them are never billed. Medicare has paid for advance care planning since 2016 under CPT 99497 (the first 30 minutes, about $87) and 99498 (each additional 30 minutes, about $75), with no cost-sharing when it's done as part of the annual wellness visit. Yet these codes are used in a small fraction of eligible visits, and in pulmonary and critical care, where the conversations are most frequent, the gap is widest. The reason isn't reluctance. The conversation happens in pieces, across visits, with nobody tracking the time or writing the note the code requires.
What that looks like for a pulmonary practice
Take an eight-physician practice. If each physician has 15 advance care planning conversations a month and bills them at 99497, that's about $125,000 a year. Add 99498 for the longer conversations, which in advanced COPD and lung cancer are common, and the number grows. This is not new work. It's the work your team already does, with documentation that lets you bill it.
How Sanctuary closes the gap
Sanctuary moves the first part of the conversation to the patient, who completes their Medical Blueprint at home, in their own words, before the visit. The clinician starts the visit with the patient's priorities already in hand. The conversation that follows is shorter, better, and documented: who was present, what was discussed, how long it took, and that it was voluntary — the elements a 99497 claim needs. The Care Guide becomes the note you can place in the chart.
For the practice, that means ACP conversations that are billable by default instead of by exception. For the patient, it means care that reflects what they said. For the clinician, it means the 2 a.m. decision is made with the patient's reasoning in front of the team.
Reimbursement figures are approximate national Medicare averages and vary by locality and payer. Sanctuary supports clinical documentation; billing decisions remain with the practice and its clinicians. UzObi does not guarantee reimbursement.
A better care plan, built on the patient's own account
Treatment choices line up with stated goals. Escalation decisions are made with the patient's reasoning in front of the team, not reconstructed from memory. Families stop relitigating what Mom would have wanted, because Mom wrote it down. For teams, it is fewer conflicted decisions, fewer ethics consults, and less moral distress.
Trust is the outcome that drives the others
Patients who feel heard follow the plan. When patients see their own words reflected in their care, they engage more, adhere more, and bring their families along. We expect that to show up as fewer unplanned admissions and fewer ICU days at the end of life, and the founding-partner pilots are how we will measure it.
What a pilot looks like
Three to six months with one practice or hospital group. We handle onboarding and training. You bring a physician champion and a panel of patients with advanced lung disease. Together we measure completion rates, clinician trust in the guides, ACP claims captured, and what changes in care plans, and we share the results with you in writing.
A founding partner gets:
A baseline of your current ACP billing, so the revenue change is measured, not estimated
Preferred subscription terms when the pilot converts to a contract
A seat at the table on what the Care Guides say and how they reach your team
Pilot sites also shape what comes next: the AI-powered platform and messaging layer we're raising capital to build, where the Medical Blueprint reaches your team at the moment it matters rather than waiting in a file.
A three-to-six-month pilot with onboarding and training handled by us
Built by clinicians, including a critical care physician and a clinical ethicist who have spent twenty years in the rooms where this goes wrong.